Patient-reported outcome measures in community mental health teams: pragmatic evaluation of PHQ-9, GAD-7 and SWEMWBS.

Paul Blenkiron,Lucy Goldsmith

doi:10.1192/bjb.2019.20

Abstract

Aims and methodWe evaluated routine use, acceptability and response rates for the Patient Health Questionnaire (PHQ-9), Generalised Anxiety Disorder Scale (GAD-7) and Short Warwick-Edinburgh Mental Well-Being Scale (SWEMWBS) within adult community mental health teams. Measures were repeated 3 months later. Professionals recorded the setting, refusal rates and cluster diagnosis. RESULTS: A total of 245 patients completed 674 measures, demonstrating good initial return rates (81%), excellent scale completion (98-99%) and infrequent refusal/unsuitability (11%). Only 32 (13%) returned follow-up measures. Significant improvements occurred in functioning (P = 0.01), PHQ-9 (P = 0.02) and GAD-7 (P = 0.003) scores (Cohen's d = 0.52-0.77) but not in SWEMWBS (P = 0.91) scores. Supercluster A had higher initial PHQ-9 and GAD-7 scores (P < 0.001) and lower SWEMWBS scores (P = 0.003) than supercluster B. Supercluster C showed the greatest functional impairment (P = 0.003).Clinical implicationsPHQ-9 and GAD-7 appear acceptable as patient-reported outcome measures in community mental health team. SWEMWBS seems insensitive to change. National outcome programmes should ensure good follow-up rates.Declaration of interestNone.

Highlights

Aims and method We evaluated routine use, acceptability and response rates for the Patient Health Questionnaire (PHQ-9), Generalised Anxiety Disorder Scale (GAD-7) and Short Warwick-Edinburgh Mental Well-Being Scale (SWEMWBS) within adult community mental health teams
Clinical implications PHQ-9 and GAD-7 appear acceptable as patient-reported outcome measures in community mental health team
This study evaluated routine use of three Patient-reported outcome measures (PROMs) within adult Community mental health teams (CMHTs): the Patient Health Questionnaire (PHQ-9), the Generalised Anxiety Disorder Scale (GAD-7) and the Short Warwick-Edinburgh Mental Well-Being Scale (SWEMWBS)

Summary

Results

Between 1.1 and 20.2% of patients in each trust were being treated on a CTO. Male gender, younger age, greater use of in-patient services, coexisting substance misuse and problems with cognition predicted use of CTOs. Community treatment orders (CTOs) were introduced in England and Wales in 2008, in an attempt to reduce the use of in-patient services for patients with poor adherence to their treatment.[1,2,3] They require individuals with mental disorders who have been detained in hospital to adhere to treatment and supervision in the community. Data submitted to NHS Digital in 2016 indicated that Black or Black British patients were almost nine times more likely to be treated on a CTO than White British patients.[13] A systematic review of data from 38 studies of clinical practice in the UK, which compared the use of in-patient mental health services by different ethnic groups, found that Black patients were over four times more likely to be admitted to hospital on a compulsory basis than White patients.[10] other studies have reported that associations between use of compulsory treatment and ethnicity may be reduced or eliminated when other sociodemographic and clinical factors are taken into account.[14,15] To date, the influence of clinical and sociodemographic factors on the association between ethnicity and use of CTOs has not been examined. Surveys of both patients and carers indicate that many believe their main aim is to try

Aims of this study

Method

Discussion