PROGRESS MONITORING

Progress Monitoring

Progress Monitoring

Literature Review

Psychiatric care, unlike physical healthcare, does not yet have the instruments available to reliably monitor patient health and alert clinicians to a negative response to treatment. This absence is concerning because relatively high rates of negative outcome occur in mental health care. Despite the widespread use of evidence-based treatments, a large proportion of patients still fail to demonstrate reliable or clinically meaningful improvement. Estimations of deterioration rates have been as high as 23%, and up to 40% of patients show no change, as illustrated in both routine clinical settings Newnham et al., 2007 and Parabiaghi et al., 2005) and randomized controlled trials. It appears that there is no typical pattern of change for all patients (Lutz et al., 2009), however monitoring progress during the therapy period provides clinicians with the opportunity to improve outcomes in real time for the benefit of each particular individual.

Monitoring programs suitable for outpatient psychological therapy have been developed in the United States and Europe, with notable success. In the US, Lambert and colleagues have developed a program of feedback to alert therapists and patients to deviations from expected response. Administration of the 45-item Outcomes Questionnaire (OQ-45) at each therapy session allows for the ongoing monitoring of progress, mapped against the patient's expected response trajectory. The expected trajectory is a function based upon the patient's severity at intake. Five studies of which four were randomized controlled trials, have demonstrated that providing feedback on patients' treatment response improved rates of clinically significant outcomes, but perhaps more importantly, reduced negative outcomes from 20% to 8%. Those studies that have demonstrated a significant improvement in outcomes have also revealed cost-efficient benefits for the use of ongoing monitoring. While the minority of cases that were identified as 'not on track' were provided two to three sessions extra, the majority were 'on track' and received one session less. Thus progress monitoring and feedback appears to improve treatment outcomes in an efficient and cost-effective manner.( Newnham, 2007)

However, one issue not addressed by the studies to date is a comparison of the quantity of psychotherapy provided. Although participants were randomly assigned to conditions, the number of sessions of therapy delivered varied across conditions. As mentioned, the cost-effectiveness of the different numbers of sessions received could be highlighted, but it does mean that the research has not revealed that the same benefits would be observed if patients in the feedback and non-feedback groups received the same quantity of therapy. Consequently, research is needed in which the amount of treatment delivered is constant across feedback and non-feedback groups to address this issue.

At present, monitoring patient response has been illustrated as an important addition to clinical practice and research within the scientific literature; however it has been greatly underutilized in practice. There are a number of arenas in which it would be beneficial to monitor treatment response more closely. The argument is particularly compelling for fields in which early response to treatment is useful information, such as drug trials; or the monitoring ...