Abstract
BackgroundRoutinely monitoring of symptoms and medical needs can improve the diagnostics and treatment of medical problems, including psychiatric. However, several studies show that few clinicians use Routine Outcome Monitoring (ROM) in their daily work. We describe the development and first evaluation of a ROM based computerized clinical decision aid, Treatment-E-Assist (TREAT) for the treatment of psychotic disorders. The goal is to generate personalized treatment recommendations, based on international guidelines combined with outcomes of mental and physical health acquired through ROM. We present a pilot study aimed to assess the feasibility of this computerized clinical decision aid in daily clinical practice by evaluating clinicians’ experiences with the system.MethodsClinical decision algorithms were developed based on international schizophrenia treatment guidelines and the input of multidisciplinary expert panels from multiple psychiatric institutes. Yearly obtained diagnostic (ROM) information of patients was presented to treating clinicians combined with treatment suggestions generated by the algorithms of TREAT. In this pilot study 6 clinicians and 16 patients of Lentis Psychiatric Institute used the application. Clinicians were interviewed and asked to fill out self-report questionnaires evaluating their opinions about ROM and the effectiveness of TREAT.ResultsSix clinicians and 16 patients with psychotic disorders participated in the pilot study. The clinicians were psychiatrists, physicians and nurse-practitioners which all worked at least 8 years in mental health care of which at least 3 years treating patients with psychotic illnesses. All Clinicians found TREAT easy to use and would like to continue using the application. They reported that TREAT offered support in using diagnostic ROM information when drafting the treatment plans, by creating more awareness of current treatment options.ConclusionThis article presents a pilot study on the implementation of a computerized clinical decision aid linking routine outcome monitoring to clinical guidelines in order to generate personalized treatment advice. TREAT was found to be feasible for daily clinical practice and effective based on this first evaluation by clinicians. However, adjustments have to be made to the system and algorithms of the application. The ultimate goal is to provide appropriate evidence based care for patients with severe mental illnesses.
Highlights
Monitoring of symptoms and medical needs can improve the diagnostics and treatment of medical problems, including psychiatric
Clinicians were positive about TREAT with an average rating of 7.5 (SD 0.84) and the integration of TREAT and Routine Outcome Monitoring (ROM) with an average rating of 7.3 (SD 1.37) on a scale from 1 to 10
Most clinicians had used TREAT at least three times during the pilot study, with the exception of one clinician who only worked with TREAT a single time
Summary
Monitoring of symptoms and medical needs can improve the diagnostics and treatment of medical problems, including psychiatric. We describe the development and first evaluation of a ROM based computerized clinical decision aid, Treatment-E-Assist (TREAT) for the treatment of psychotic disorders. Patients frequently experience problems with psychosocial functioning, such as a lack of daytime activities, social contacts, intimate relationships and a reduced quality of life [3, 4]. They often have poor physical health and experience medication side effects that contribute to an early onset of cardiovascular diseases. Patients with the most severe symptoms (fulfilling criteria for schizophrenia or schizoaffective disorders) often need lifetime medical, psychiatric and social care. There is a challenge to monitor symptoms and unmet care needs of these patients in order to offer optimal care, especially in realizing their varying needs in different domains for many years
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