Measurement-based Care For Patients With MDD
Clinicians, particularly those treating major depressive disorder (MDD), know all too well that symptom presentation does not guarantee a quick and accurate diagnosis. There are many factors at play, from limited time with patients to forgotten questions and inaccurate responses. Because of these variables, there could be years between symptom presentation and an accurate clinical diagnosis.
Integrating measurement-based care into clinical practice by using self-report assessments like the Patient Health Questionnaire-9, the Generalized Anxiety Disorder-7, or the HERO Wellness Scale can help clinicians accurately assess their patients’ depressive symptoms, medication side effects, and medication adherence. And with consistent follow-up (every 2-4 weeks), clinicians stay in touch with their patients, potentially improving patient engagement.
Saundra Jain, MA, PsyD, LPC, and Manish K. Jha, MD, discussed the importance of adopting measurement-based care during their session, “Measurement-Based Care: What Is It and How To Make It Work For Your Patients,” at the Psych Congress meeting in New Orleans, LA on Saturday, September 17, 2022.1 Dr Jain is an Adjunct Clinical Affiliate at the University of Texas at Austin School of Nursing in Austin, Texas. Dr Jha is an Assistant Professor of Psychiatry at the Center for Depression Research and Clinical Care at UT Southwestern Medical Center in Dallas, Texas.
The presenters began the session with a survey of the Psych Congress to better understand what the members knew about psychiatric scales and screeners (n = 169). The survey showed that in the care of patients with MDD, 28.99% of those surveyed used scales and screeners 100% of the time, while about 22.49% of those surveyed used screeners less than 25% of the time.
Next, they discussed the importance of adopting measurement-based care through the systematic use of self-report measures, regular follow-up, and clinical decision support tools. While studies have demonstrated that measurement-based care can increase the rates of clinically meaningful improvements in patients with serious mental illnesses, this approach in clinical practice remains limited. But according to Dr Jain and Dr Jha, there are several advantages to adopting measurement-based care. They listed their top 5:
- Can be used as powerful patient education tools
- Assists clinicians with active surveillance of chronic conditions
- Improves patient engagement and strengthen patient relationships
- Provides more robust documentation
- Time efficient and cost-effective
The presenters then described how measurement-based care can tie into shared-decision making with the patient. For example, when trying to determine which antidepressant medication is appropriate, the clinician can present the available options based on the assessments while the patient offers his or her own values and preferences. The use of decision aids can help the patient and the clinician exchange valuable information and come to a decision together.
Finally, they concluded their presentation by identifying several measurement-based care tools and described how to integrate them into one’s clinical practice. For example, the HERO Wellness Scale is a wellness scale where the patient tracks their own wellness. With a range of 0-50, the higher scores indicate the patient’s higher levels of wellness. This scale allows the patient to become an active participant in their wellness.
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— Anthony Calabro
Jain S, Jha MK. Measurement-based care: what is it and how to make it work for your patients. Talk presented at: Psych Congress 2022; September 17-20, 2022. New Orleans, LA. Accessed September 27, 2022. https://www.national.psychcongress.com/