TY - JOUR
T1 - Measurement-based care for refractory depression
T2 - A clinical decision support model for clinical research and practice
AU - Trivedi, Madhukar H.
AU - Daly, Ella J.
N1 - Funding Information:
This project has been funded with Federal funds from the National Institute of Mental Health, National Institutes of Health, under 5R01MH064062-2 (Computerized Decision Support System for Depression—IMPACTS) and NIMH 5R01MH067692-2.
PY - 2007/5
Y1 - 2007/5
N2 - Despite years of antidepressant drug development and patient and provider education, suboptimal medication dosing and duration of exposure resulting in incomplete remission of symptoms remains the norm in the treatment of depression. Additionally, since no one treatment is effective for all patients, optimal implementation focusing on the measurement of symptoms, side effects, and function is essential to determine effective sequential treatment approaches. There is a need for a paradigm shift in how clinical decision making is incorporated into clinical practice and for a move away from the trial-and-error approach that currently determines the "next best" treatment. This paper describes how our experience with the Texas Medication Algorithm Project (TMAP) and the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial has confirmed the need for easy-to-use clinical support systems to ensure fidelity to guidelines. To further enhance guideline fidelity, we have developed an electronic decision support system that provides critical feedback and guidance at the point of patient care. We believe that a measurement-based care (MBC) approach is essential to any decision support system, allowing physicians to individualize and adapt decisions about patient care based on symptom progress, tolerability of medication, and dose optimization. We also believe that successful integration of sequential algorithms with MBC into real-world clinics will facilitate change that will endure and improve patient outcomes. Although we use major depression to illustrate our approach, the issues addressed are applicable to other chronic psychiatric conditions including comorbid depression and substance use disorder as well as other medical illnesses.
AB - Despite years of antidepressant drug development and patient and provider education, suboptimal medication dosing and duration of exposure resulting in incomplete remission of symptoms remains the norm in the treatment of depression. Additionally, since no one treatment is effective for all patients, optimal implementation focusing on the measurement of symptoms, side effects, and function is essential to determine effective sequential treatment approaches. There is a need for a paradigm shift in how clinical decision making is incorporated into clinical practice and for a move away from the trial-and-error approach that currently determines the "next best" treatment. This paper describes how our experience with the Texas Medication Algorithm Project (TMAP) and the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) trial has confirmed the need for easy-to-use clinical support systems to ensure fidelity to guidelines. To further enhance guideline fidelity, we have developed an electronic decision support system that provides critical feedback and guidance at the point of patient care. We believe that a measurement-based care (MBC) approach is essential to any decision support system, allowing physicians to individualize and adapt decisions about patient care based on symptom progress, tolerability of medication, and dose optimization. We also believe that successful integration of sequential algorithms with MBC into real-world clinics will facilitate change that will endure and improve patient outcomes. Although we use major depression to illustrate our approach, the issues addressed are applicable to other chronic psychiatric conditions including comorbid depression and substance use disorder as well as other medical illnesses.
KW - Adaptive treatment strategies
KW - Decision support systems
KW - Depression
KW - Measurement-based care
UR - http://www.scopus.com/inward/record.url?scp=34047180144&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=34047180144&partnerID=8YFLogxK
U2 - 10.1016/j.drugalcdep.2007.01.007
DO - 10.1016/j.drugalcdep.2007.01.007
M3 - Article
C2 - 17320312
AN - SCOPUS:34047180144
SN - 0376-8716
VL - 88
SP - S61-S71
JO - Drug and Alcohol Dependence
JF - Drug and Alcohol Dependence
IS - SUPPL. 2
ER -