Therapist engagement in measurement-based care: The association between client outcomes and therapist viewing frequency.

Engagement in measurement-based care (MBC) has been shown to be an effective practice for optimizing psychotherapy outcomes. Best practices for MBC suggest that it is crucial for therapists to consistently review scores. However, the exact impact of this practice on MBC's effectiveness has yet to be fully elucidated. The current study examined the association between the frequency of therapists reviewing clients' depression scores and client psychotherapy outcomes. The sample consisted of 6182 clients diagnosed with depression who sought treatment from 2248 therapists through a practice research group. Patient Health Questionnaire-9 (PHQ-9) was administered prior to sessions, and therapists could access the scores via their therapist portal. The results based on multilevel modelling revealed that how often therapists view their clients' PHQ-9 results was not a significant predictor of therapy outcomes. However, therapists who, across their caseloads, viewed client PHQ-9 scores more frequently facilitated better treatment outcomes. These results suggest that therapists who routinely engage in MBC facilitate better therapy outcomes. Implications for practice and research are provided.

Measurement-based care professional practice guideline: Don't forget the therapists!

Boswell et al. (2022) professional practice guideline builds an excellent, evidence-driven argument in favor of the routine implementation of measurement-based care (MBC). Nonetheless, as learned from the attempted implementation of evidence-based psychotherapies, presenting empirical evidence does not affect therapist behavior. As such, we argue for an actionable and practical professional practice guideline. We review some of the most hindering barriers to the implementation of MBC, and we offer guidance introducing some of the efforts needed to overcome them. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Development of a Symptom-Focused Model to Guide the Prescribing of Antipsychotics in Children and Adolescents: Results of the First Phase of the Safer Use of Antipsychotics in Youth (SUAY) Clinical Trial.

OBJECTIVE: To develop a new approach to prescribing guidelines as part of a pragmatic trial, Safer Use of Antipsychotics in Youth (SUAY; ClinicalTrials.gov Identifier: NCT03448575), which supports prescribers in delivering high-quality mental health care to youths. METHOD: A nominal group technique was used to identify first- to nth-line treatments for target symptoms and potential diagnoses. The panel included US pediatricians, child and adolescent psychiatrists, and psychopharmacology experts. Meeting materials included information about Medicaid review programs, systematic reviews, prescribing guidelines, and a description of the pragmatic trial. Afterward, a series of 4 webinar discussions were held to achieve consensus on recommendations. RESULTS: The panel unanimously agreed that the guideline should focus on target symptoms rather than diagnoses. Guidance included recommendations for first- to nth-line treatment of target mental health symptoms, environmental factors to be addressed, possible underlying diagnoses that should first be considered and ruled out, and general considerations for pharmacological and therapeutic treatments. CONCLUSION: Prescribing guidelines are often ignored because they do not incorporate the real-world availability of first-line psychosocial treatments, comorbid conditions, and clinical complexity. Our approach addresses some of these concerns. If the approach proves successful in our ongoing pragmatic trial, Safer Use of Antipsychotics in Youth (SUAY), it may serve as a model to state Medicaid programs and health systems to support clinicians in delivering high-quality mental health care to youths. CLINICAL TRIAL REGISTRATION INFORMATION: Safer Use of Antipsychotics in Youth; http://clinicaltrials.gov/; NCT03448575.

Accuracy of Electronic Health Record-Derived Data for the Identification of Incident ADHD.

OBJECTIVE: To assess the accuracy of electronic health record (EHR)-derived diagnoses in identifying children with incident (i.e., newly diagnosed) ADHD. METHOD: In 10 large health care organizations, electronic diagnoses data were used to identify all potential cases of incident ADHD among 3- through 9-year-old children. A random sample of records was manually reviewed to determine whether a diagnosis of ADHD was documented in clinician notes. RESULTS: From electronic diagnoses data, a total of 7,362 children with incident ADHD were identified. Upon manual review of 500 records, the diagnosis of incident ADHD was confirmed in clinician notes for 71.5% (95% confidence interval [CI] = [56.5, 86.4]) of records for 3- through 5-year-old children and 73.6% (95% CI = [65.6, 81.6]) of records for 6- through 9-year-old children. CONCLUSION: Studies predicated on the identification of incident ADHD cases will need to carefully consider study designs that minimize the likelihood of case misclassification.

Screening for and Diagnosis of Depression Among Adolescents in a Large Health Maintenance Organization.

OBJECTIVE: The aim of this analysis was to determine changes in patterns of depression screening and diagnosis over three years in primary and specialty mental health care in a large health maintenance organization (HMO) as part of a project to develop quality measures for adolescent depression treatment. METHODS: Two series of aggregate data (2010-2012) were gathered from the electronic health records of the HMO for 44,342 unique adolescents (ages 12 to 21) who had visits in primary and mental health care. Chi square tests assessed the significance of changes in frequency and departmental location of Patient Health Questionnaire-9 (PHQ-9) administration, incidence of depression symptoms, and depression diagnoses. RESULTS: There was a significant increase in PHQ-9 use, predominantly in primary care, consistent with internally generated organizational recommendations to increase screening with the PHQ-9. The increase in PHQ-9 use led to an increase in depression diagnoses in primary care and a shift in the location of some diagnoses from specialty mental health care to primary care. The increase in PHQ-9 use was also linked to a decrease in the proportion of positive PHQ-9 results that led to formal depression diagnoses. CONCLUSIONS: The rate of depression screening in primary care increased over the study period. This increase corresponded to an increase in the number of depression diagnoses made in primary care and a shift in the location in which depression diagnoses were made, from the mental health department to primary care. The frequency of positive PHQ-9 administrations not associated with depression diagnoses also increased.

Pharmacotherapy for incident attention-deficit/hyperactivity disorder: practice patterns and quality metrics.

INTRODUCTION: This study examines incident treatment patterns for attention-deficit/hyperactivity disorder (ADHD) in children seen in eight integrated healthcare delivery systems and identifies factors associated with adherence to Healthcare Effectiveness Data and Information Set (HEDIS) quality measures developed by the National Committee for Quality Assurance (NCQA). METHOD: A retrospective cohort analysis using electronic healthcare data from children aged 3 through 17 years with newly diagnosed ADHD between January 1, 2009 and December 31, 2010 was conducted. NCQA quality definitions for initiation and for continuation and maintenance (C&M) of ADHD medications were expanded to include preschoolers and adolescents. Poisson regression models with robust error variance were used to evaluate the association between NCQA HEDIS adherence measures, provider type, patient characteristics and care process measures. RESULTS: Of 6864 children aged 3-17 years old qualifying for incident treatment analyses, 5538 (80.7%) were started on ADHD medication within a year of diagnosis. Adherence to NCQA HEDIS measures was 49.8% for initiation and 45.8% for C&M, with adherence rates higher for mental health than non-mental health providers, school-aged children than adolescents, and for patients concurrently on other psychotropic medications than those who were not. Of those started on ADHD medication, 62.3% were not eligible for C&M analyses according to HEDIS guidelines, because they did not receive continuous (210 of 300 days) ADHD medication treatment, with adolescents less likely than school-aged children to persist with medications. CONCLUSION: Study limitations must be considered, including reliance on electronic medical record data, absence of patient race and sociodemographic data, and limited generalizability to other care contexts. Nevertheless, findings suggest novel strategies are needed to improve the quality of ADHD care processes for children of all ages, because even within integrated delivery systems less than half of children with ADHD received care consistent with NCQA HEDIS standards for initiation and C&M care. RESULTS suggest the need to refine quality measures by including follow-up care in those children not receiving or discontinuing medication treatment, a considerable quality concern not currently captured in NCQA HEDIS standards.

Quality and peer review of research: an adjudicating role for editors.

Peer review gives research a stamp of approval, but the reviews themselves can be flawed. This is potentially serious for the writer, the journal, and journal user. This study describes shortcomings of the peer review process and condenses them into an explanatory framework involving situational, personal, social, and ethical factors. Some proposals to improve matters are impractical and may make them worse. Some data is offered which illustrates the problem and suggests a potential solution. Informed editors who avoid mechanical approaches engage cautiously and critically with reviews and guard against bias, even in themselves, could make a significant difference.

Clinical evaluation of a simple uroflowmeter for categorization of maximum urinary flow rate.

OBJECTIVE: To evaluate the accuracy and diagnostic usefulness of a disposable flowmeter consisting of a plastic funnel with a spout divided into three chambers. MATERIALS AND METHODS: Men with lower urinary tract symptoms (LUTS) voided sequentially into a standard flowmeter and the funnel device recording maximum flow rate (Q(max)) and voided volume (V(void)). The device was precalibrated such that filling of the bottom, middle and top chambers categorized maximum input flows as <10, 10-15 and > 15 ml s(-1) respectively. Subjects who agreed to use the funnel device at home obtained readings of flow category and V(void) twice daily for seven days. RESULTS: A single office reading in 46 men using the device showed good agreement with standard measurement of Q(max) for V(void) > 150 ml (Kappa = 0.68). All 14 men whose void reached the top chamber had standard Q(max) > 15 ml s(-1) (PPV = 100%, NPV = 72%) whilst eight of 12 men whose void remained in the bottom chamber had standard Q(max) < 10 ml s(-1) (PPV = 70%, NPV = 94%). During multiple home use by 14 men the device showed moderate repeatability (Kappa = 0.58) and correctly categorized Q(max) in comparison to standard measurement for 12 (87%) men. CONCLUSIONS: This study suggests that the device has sufficient accuracy and reliability for initial flow rate assessment in men with LUTS. The device can provide a single measurement or alternatively multiple home measurements to categorize men with Q(max) < 15 ml s(-1).

Predicting negative drinking consequences: examining descriptive norm perception.

OBJECTIVE: This study explored how much variance in college student negative drinking consequences is explained by descriptive norm perception, beyond that accounted for by student gender and self-reported alcohol use. METHOD: A derivation sample (N=7565; 54% women) and a replication sample (N=8924; 55.5% women) of undergraduate students completed the Campus Alcohol Survey in classroom settings. RESULTS: Hierarchical regression analyses revealed that student gender and average number of drinks when "partying" were significantly related to harmful consequences resulting from drinking. Men reported more consequences than did women, and drinking amounts were positively correlated with consequences. However, descriptive norm perception did not explain any additional variance beyond that attributed to gender and alcohol use. Furthermore, there was no significant three-way interaction among student gender, alcohol use, and descriptive norm perception. CONCLUSIONS: Norm perception contributed no significant variance in explaining harmful consequences beyond that explained by college student gender and alcohol use.

College student protective strategies and drinking consequences.

OBJECTIVE: This study explored the relationships between college student gender, alcohol use, protective strategies and harmful drinking consequences. METHOD: A derivation sample (N = 3,851; 54% women) and a replication sample (N = 4,151; 55% women) of undergraduate students completed the Campus Alcohol Survey (CAS) in classroom settings. RESULTS: Although women drank less than men and were less likely to experience harmful consequences, they were more likely to use protective strategies. Hierarchical regression analyses revealed that students who consumed at least six drinks when they partied--especially men-were less likely to experience more common consequences (e.g., poor academic performance, property damage, unconsciousness, riding in a vehicle with others who have been drinking) if they engaged in self-protective strategies. Such strategies also helped students who exceeded the median number of drinks to moderate the effect of drinking on less common consequences (e.g., vehicular accidents, class failure, conflicts with authorities). CONCLUSIONS: These findings add to the growing literature on contextual events that protect students from harm while drinking.