Computerized Medication Algorithms in Behavioral Health Care

Trivedi, Madhukar H.; Kern, Janet K.; Voegtle, Tracy M.; Baker, Shannon M.; Altshüler, Kenneth Z.

doi:10.1007/978-0-387-21586-0_5

Cited by 6 publications

(5 citation statements)

References 46 publications

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“…Computerized clinical guidelines can overcome some of the barriers to conventional text-form guidelines because the computerized program, i. e., prompts, alerts, and full-fledged support, are integrated with systems that routinely store and retrieve patient information and can improve workflow by providing physicians with patient-specific advice based upon the integrated data at the time of the patient visit. A growing list of studies indicates that there are improvements in physician use and compliance with guidelines when furnished in a computerized format (1,2,(32)(33)(34)(35). However, computerized programs have novel aspects that have to be considered such as technical problems and limitations, lack of adequate technical support, inadequate technology integration with workflow practices, and poor user-interface design that can act as barriers.…”

Section: Discussionmentioning

confidence: 99%

Development and Implementation of Computerized Clinical Guidelines: Barriers and Solutions

Trivedi¹,

Kern²,

Marcee³

et al. 2002

Methods Inf Med

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SummaryNext, the article discusses the need to incorporate the use of surveys, questionnaires, or rating instruments for the collection of end-user feedback during and after the implementation process. A description of the types of rating instruments that will facilitate the assessment of user satisfaction is provided. Initial results from physician feedback during the implementation of our prototype are discussed. Research indicates that computerized decision support systems (CDSSs) can improve clinical performance and patient outcomes, and yet CDSSs are not in widespread use. Physician guidelines, in general, face barriers in implementation. Guidelines in a computerized format can overcome some of the barriers to conventional text-form guidelines; however, computerized programs have novel aspects that have to be considered, aspects such as technical problems/support and user interface issues that can act as barriers. Though the literature points out that human, organizational, and technical issues can act as barriers in the implementation of CDSSs, studies clearly indicate that there are methods that can overcome these barriers and improve CDSS acceptance and use. These methods come from lessons learned from a variety of CDSS implementation ventures. Notably, most of the methods that improve acceptance and use of a CDSS require feedback and involvement of end-users. Measuring and addressing physician or user attitudes toward the computerized support system has been shown to be important in the successful implementation of a CDSS. This article discusses: 1) the barriers of implementation of guidelines in general and of CDSSs; 2) the importance of the physician’s role in development, implementation, and adherence; 3) methods that can improve CDSS acceptance and use; and 4) the types of tools needed to obtain end-user feedback.

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Section: Discussionmentioning

confidence: 99%

Development and Implementation of Computerized Clinical Guidelines: Barriers and Solutions

Trivedi¹,

Kern²,

Marcee³

et al. 2002

Methods Inf Med

View full text Add to dashboard Cite

show abstract

“…At the practitioner level, we need to explore mechanisms to increase algorithm adherence, including academic detailing, continuous quality improvement, and computerized decision support systems. [87][88][89] At the organizational level, we need to explore modes that more efficiently implement change and more effectively allow practitioners to provide care. As noted in the Institute of Medicine's report, "Crossing the Quality Chasm: A New Health System for the 21st Century," 90 improving the quality of health care in the United States requires not only changing health care profession-als and organizations but also better methods of disseminating information, application of technology, communication systems, and the creation of payment systems that reward positive performance.…”

Section: Clinical Efficacymentioning

confidence: 99%

Clinical Results for Patients With Major Depressive Disorder in theTexas Medication Algorithm Project

Trivedi

Rush

Crismon

et al. 2004

Arch Gen Psychiatry

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217

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“…The database also stores user-specific data and the reference tables for medications and dosage. This computer platform can be connected with other software files (i.e., administrative databases) to allow the collection of data required for specialized services, such as billing or reporting [38,39]. A step-by-step description of progression through the software program is provided in Appendix 1, and diagrams of the five basic screens associated with the software are found in Figures 2-6.…”

Section: Computer Softwarementioning

confidence: 99%

Assessing Physicians' Use of Treatment Algorithms: Project IMPACTS Study Design and Rationale

Trivedi¹,

Claassen

Grannemann

et al. 2007

Contemporary Clinical Trials

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Effective treatments for major depressive disorder have been available for 35 years, yet inadequate pharmacotherapy continues to be widespread leading to suboptimal outcomes. Evidence-based medication algorithms have the potential to bring much-needed improvement in effectiveness of antidepressant treatment in "real-world" clinical settings. Project IMPACTS (Implementation of Algorithms using Computerized Treatment Systems) addresses the critical question of how best to facilitate integration of depression treatment algorithms into routine care. It tests an algorithm implemented through a computerized decision support system using a measurement-based care approach for depression against a paper-and-pencil version of the same algorithm and non-algorithm-based, specialist-delivered usual care. This paper reviews issues related to the Project IMPACTS study rationale, design, and procedures. Patient outcomes include symptom severity, social and work function, and quality of life. The economic impact of treatment is assessed in terms of health care utilization and cost. Data collected on physician behavior include degree of adherence to guidelines and physician attitudes about the perceived utility, ease of use, and self-reported effect of the use of algorithms on workload. Novel features of the design include a two-tiered study enrollment procedure, which initially enroll physicians as subjects, and then following recruitment of physicians, enrollment of subjects takes place based initially on an independent assessment by study staff to determine study eligibility. The study utilizes brief, easy-to-use symptom severity measures that facilitate physician decision making, and it employs a validated, phone-based, follow-up assessment protocol in order to minimize missing data, a problem common in public sector and longitudinal mental health studies. IMPACTS will assess the success of algorithm implementation and subsequent physician adherence using study-developed criteria and related statistical approaches. These new procedures and data points will also allow a more refined assessment of algorithm-driven treatment in the future.

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Computerized Medication Algorithms in Behavioral Health Care

Cited by 6 publications

References 46 publications

Development and Implementation of Computerized Clinical Guidelines: Barriers and Solutions

Development and Implementation of Computerized Clinical Guidelines: Barriers and Solutions

Clinical Results for Patients With Major Depressive Disorder in theTexas Medication Algorithm Project

Assessing Physicians' Use of Treatment Algorithms: Project IMPACTS Study Design and Rationale

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