Empirische evidence voor de effectiviteit van routine outcome monitoring; een literatuuronderzoek

achtergrond Routine outcome monitoring (ROM) is een belangrijk kwaliteitsinstrument om effecten van behandeling zichtbaar te maken en wordt landelijk geïmplementeerd in de Nederlandse ggz. doel Evalueren van de wetenschappelijke stand van zaken betreffende de effectiviteit van ROM voor diagnostiek, behandeling en andere uitkomsten. methode Literatuuronderzoek in PubMed, Medline, Psycinfo en Embase Psychiatry (1975-2009) naar gerandomiseerde gecontroleerde trials (rct\u27s) van ROM bij alle leeftijdsgroepen patiënten (algemeen en ggz). De voornaamste zoektermen waren \u27routine outcome monitoring\u27 c.q. \u27routine outcome measurement\u27. resultaten Er werden 52 rct\u27s geïncludeerd betreffende ROM bij volwassen patiënten. Hiervan waren 45 rct\u27s gericht op psychische klachten, zij het niet altijd in een psychiatrische setting of als primaire uitkomstmaat. Er bleken positieve effecten van ROM op de diagnostiek en behandeling, en op de communicatie tussen patiënt en behandelaar. Andere uitkomsten waren minder eenduidig. conclusie ROM blijkt vooral effectief voor het monitoren van behandelingen die onvoldoende aanslaan. Nader onderzoek is nodig naar de klinische effectiviteit en de kosteneffectiviteit van ROM in zowel de volwassenen- als de kinder- en jeugdpsychiatrie

Optimal screening for increased risk for adverse outcomes in hospitalised older adults

Background: screening for frailty might help to prevent adverse outcomes in hospitalised older adults. Objective: to identify the most predictive and efficient screening tool for frailty. Design and setting: two consecutive observational prospective cohorts in four hospitals in the Netherlands. Subjects: patients aged ≥70 years, electively or acutely hospitalised for ≥2 days. Methods: screening instruments included in the Dutch Safety Management Programme [VeiligheidsManagementSysteem (VMS)] on four geriatric domains (ADL, falls, undernutrition and delirium) were used and the Identification of Seniors At Risk, the 6-item Cognitive Impairment Test and the Mini-Mental State Examination were assessed. Three months later, adverse outcomes including functional decline, high-healthcare demand or death were determined. Correlation and regression tree analyses were performed and predictive capacities were assessed. Results: follow-up data were available of 883 patients. All screening instruments were similarly predictive for adverse outcome ( predictive power 0.58–0.66), but the percentage of positively screened patients (13–72%), sensitivity (24–89%) and specificity (35–91%) highly differed. The strongest predictive model for frailty was scoring positive on ≥3 VMS domains if aged 70–80 years; or being aged ≥80 years and scoring positive on ≥1 VMS domains. This tool classified 34% of the patients as frail with a sensitivity of 68% and a specificity of 74%. Comparable results were found in the validation cohort. Conclusions: the VMS-tool plus age (VMS+ ) offers an efficient instrument to identify frail hospitalised older adults at risk for adverse outcome. In clinical practice, it is important to weigh costs and benefits of screening given the rather low-predictive power of screening instruments

A randomized controlled trial of the efficacy and cost-effectiveness of a brief intensified cognitive behavioral therapy and/or pharmacotherapy for mood and anxiety disorders: Design and methods

Background: Anxiety and mood disorders involve a high disease burden and are associated with high economic costs. A stepped-care approach intervention and abbreviated diagnostic method are assumed to increase effectiveness and efficiency of the mental healthcare and are expected to reduce economic costs. Methods: Presented are the rationale, design, and methods of a two-armed randomized controlled trial comparing \u27treatment as usual\u27 (TAU) with a brief intensified cognitive behavioral therapy (CBT) and/or pharmacotherapy. Eligible participants (N =500) of five Dutch outpatient Mental Healthcare Centers are randomly assigned to either TAU or to the experimental condition (brief CBT and/or pharmacotherapy). Data on patients\u27 progress and clinical effectiveness of treatment are assessed at baseline, post-treatment (3. months after baseline), and at 6 and 12. months post-treatment by Routine Outcome Monitoring (ROM). Cost analysis is performed on the obtained data. Discussion: Since few studies have investigated both the clinical and cost effectiveness of a stepped-care approach intervention and a shortened diagnostic ROM method in both anxiety and/or mood disorders within secondary mental health care, the results of this study might contribute to the improvement of (cost)-effective treatment options and diagnostic methods for these disorders

Assessing adherence to guidelines for common mental disorders in routine clinical practice

Stress-related psychiatric disorders across the life spa

Assessing adherence to guidelines with administrative data in psychiatric outpatients

Stress-related psychiatric disorders across the life spa