Measurement-Based Care Efficacy in Mental Health

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Measurement-Based Care Efficacy in Mental Health

Key Takeaways

  • Studies comparing the efficacy of telehealthcare versus in-patient care in mental health patients generally find no significant difference in clinical outcomes.
  • A study that mental health patients stayed longer when they were treated remotely than when they were treated in-person, but found no significant difference in "depressive symptom reduction, and significant increases in self-reported quality of life across both groups."
  • A study found that telepsychiatry delivered results that were as good as outcomes achieved via face-to-face. In addition, telepsychiatry was at least 10% cheaper on a per-patient basis compared to when service was provided face to face.

Introduction

Studies on the efficacy of measurement-based care in telepsychiatry or remote/tele-mental/behavioral healthcare vs. brick and mortar/in-person have been provided below.

1) Comparing the efficacy of telehealth to in-person mental health care in intensive-treatment-seeking adults

  • The study compared "the clinical outcomes of a matched sample of patients in a private, nation-wide behavioral health treatment system who received in-person, intensive psychological treatment prior to the COVID-19 pandemic (N = 1,192) to the outcomes of a distinctive group of patients who received telehealth treatment during the pandemic (N = 1,192)."
  • The study found that patients stayed longer when they were treated remotely than when they were treated in-person.
  • However, the study found no significant differences between telehealth and in-person groups in "depressive symptom reduction, and significant increases in self-reported quality of life across both groups."
  • The scoring system used in the measurement are the Quick Inventory of Depressive Symptomatology-Self-Report (QIDS-SR) for the depressive symptoms and Quality of Life Enjoyment and Satisfaction Questionnaire (Q-LES-Q) for quality of life.

2) Is telepsychiatry equivalent to face-to-face psychiatry? Results from a randomized controlled equivalence trial

  • The study evaluated the clinical outcomes of telepsychiatry to understand if they are as good as outcomes achieved via face-to-face consultations in Canada.
  • A total of 495 patients in Ontario were randomly assigned to be examined by telepsychiatry (N=241) or face-to-face (N=254).
  • The study found that telepsychiatry delivered results that were as good as outcomes achieved via face-to-face. In addition, telepsychiatry was at least 10% cheaper on a per-patient basis compared to when service was provided face to face.
  • The scoring systems used in the study are the Brief Symptom Inventory (BSI), The Global Severity Index (GSI), Medical Outcomes Study Short Form (SF-36), and the Client Satisfaction Questionnaire (CSQ-8).

3) Clinical and economic outcomes of remotely delivered cognitive behaviour therapy versus treatment as usual for repeat unscheduled care users with severe health anxiety: a multicentre randomised controlled trial

  • The study investigated "whether clinical and economic outcomes were improved by offering remote cognitive behaviour therapy (RCBT) using videoconferencing or telephone compared to treatment as usual (TAU)."
  • The study was a single-blind, randomized clinical trial that involved 156 adult patients that scored >18 on the Health Anxiety Inventory. Of the 156 patients that were recruited for the study, 78 were randomised to RCBT and 78 to TAU.
  • The study found that "compared to TAU, RCBT significantly reduced health anxiety at six months, maintained to 9 and 12 months (mean change difference HAI –2.81; 95% CI –5.11 to –0.50; P = 0.017). Generalised anxiety, depression and overall health was significantly improved at 12 months, but there was no significant change in physical symptoms or function."
  • RCBT was also found to save cost of £3,164 per participant, compared to TAU.
  • The scoring systems used in the study is the Health Anxiety Inventory.

4) Comparing telehealth-based and clinic-based group cognitive behavioral therapy for adults with depression and anxiety: a pilot study

  • The study evaluated the "reliable adherence to a group cognitive behavioral (CBT) therapy protocol when delivered using on-line video conferencing as compared with face-to-face delivery of group CBT. A secondary aim was to show comparability of changes in subject depression inventory scores between on-line and face-to-face delivery of group CBT."
  • The study involved 18 participants and found similar adherence to the CBT protocol as well as similar improvement scores, with "60% of participants in each group showing a positive change in BDI-II severity classification."
  • The scoring system for the study were DSM-IV (Diagnostic and Statistical Manual of Mental Disorders, 4th Edition) and Beck Depression Inventory Second Edition (BDI-II).

5) Practice-based versus telemedicine-based collaborative care for depression in rural federally qualified health centers: a pragmatic randomized comparative effectiveness trial

  • The study evaluated the outcomes of patients assigned to practice-based and telemedicine-based collaborative care.
  • The study involved 364 patients who screened positive for depression were enrolled in the study and followed for 18 months. Patients were divided into two groups: practice-based collaborative care group that received evidenced-based care from an on-site primary care provider and telemedicine-based collaborative care group that received evidence-based care from an on-site primary care provider via telephone and videoconfrencing.
  • The study found "greater reductions in severity over time for patients in the telemedicine-based group. Improvements in outcomes appeared to be attributable to higher fidelity to the collaborative care evidence base in the telemedicine-based group."
  • The scoring system for the study was Hopkins Symptom Checklist.

Research Strategy

Our research team restricted our search for studies on the efficacy of measurement-based care in telepsychiatry or remote/tele-mental/behavioral healthcare vs. brick and mortar/in-person to studies published in peer-reviewed journals. This also ensured that only scoring systems that are acceptable to the academic community were used as peer-reviewed journals typically enforce this standard.

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