Implementing Measurement-Based Care for Depression: Practical Solutions for Psychiatrists and Primary Care Physicians

Abstract

Measurement-based care (MBC) can be defined as the clinical practice in which care providers collect patient data through validated outcome scales and use the results to guide their decision-making processes. Despite growing evidence supporting the effectiveness of MBC for depression and other mental health conditions, many physicians and mental health clinicians have yet to adopt MBC practice. In part, this is due to individual and organizational barriers to implementing MBC in busy clinical settings. In this paper, we briefly review the evidence for the efficacy of MBC focusing on pharmacological management of depression and provide example clinical scenarios to illustrate its potential clinical utility in psychiatric settings. We discuss the barriers and challenges for MBC adoption and then address these by suggesting simple solutions to implement MBC for depression care, including recommended outcome scales, monitoring tools, and technology solutions such as cloud-based MBC services and mobile health apps for mood tracking. The availability of MBC tools, ranging from paper-pencil questionnaires to mobile health technology, can allow psychiatrists and clinicians in all types of practice settings to easily incorporate MBC into their practices and improve outcomes for their patients with depression.

The Efficacy of Measurement-Based Care for Depressive Disorders

“…6,9,10 MBC includes (1) routine administration of validated rating scales, either by clinician-rated or patient-reported outcomes (PROs); (2) review of scores by practitioners and patients; and (3) using scores to inform shared clinical decision-making. 11,12 MBC has specifically been recommended for the management of MDD by the American Psychiatric Association (APA), 13 Canadian Network for Mood and Anxiety Treatments (CANMAT), 14 and UK National Institute for Health and Care Excellence (NICE) 15 clinical practice guidelines.…”

EMBED Phase 2 Study Protocol v.1.4: A Cluster Randomized Controlled Trial of Enhanced versus Standard Measurement-Based Care Implementation for Depression

“…Measurement-based care (MBC)the routine use of simple, validated outcome scales such as the Patient Health Questionnaire (PHQ-9) depression scale [6] to guide clinical decision-making in treating MDDis an EBP that may help meet these ambitious objectives [7]. The self-rated PHQ-9 can be helpful in screening, diagnosis and monitoring treatment; in primary care and other settings, the PHQ-9 can increase the recognition of MDD and improve outcomes when used within an MBC management approach [7]. For example, simple algorithms based on PHQ-9 scores can help physicians decide when to change the dose of an antidepressant or when to switch to another [7,8].…”

“…The self-rated PHQ-9 can be helpful in screening, diagnosis and monitoring treatment; in primary care and other settings, the PHQ-9 can increase the recognition of MDD and improve outcomes when used within an MBC management approach [7]. For example, simple algorithms based on PHQ-9 scores can help physicians decide when to change the dose of an antidepressant or when to switch to another [7,8]. Importantly, it can help identify which patients are not improving so that more intensive treatment can be offered.…”

“…The concept of enhanced MBC (eMBC), in which mobile health (mHealth) tools and services can engage both patients and physicians in using MBC, may also offer solutions to some of the identified barriers [7,22]. These enhancements include online or mobile apps for patients to monitor and track progress using validated self-rating scales such as the PHQ-9.…”

A Comparative Evaluation of Measurement-Based Psychiatric Care Delivered via Specialized Telemental Health Platform Versus Treatment As Usual: A Retrospective Analysis

“…Meta-analyses of these studies have demonstrated that patients using smartphone apps show a greater improvement in symptoms vs. controls, with a greater effect when compared with inactive than active control conditions, encouraging the integration of MHApps into the treatment of important and common psychiatric illnesses [25,26]. Many of these tools empower patients by enabling them to track their progress and become active participants in their healthcare journeys [27]. Moreover, many apps serve as useful methods for monitoring and facilitating early identification of risk and thus help mitigate negative psychiatric outcomes [28].…”