Cochrane review of patient reported outcome measures in the routine monitoring of common mental health disorders

Talk Code: 
EP3B.09
Presenter: 
Tony Kendrick
Co-authors: 
Magdy El-Gohary, Beth Stuart, Michael Moore
Author institutions: 
University of Southampton

Problem

Routine monitoring of common mental health disorders (CMHDs), using patient reported outcome measures (PROMs), has been promoted but may be costly, given their high prevalence.

Approach

We searched the Cochrane CCDAN database and Library, Oxford University PROMS Bibliography, Ovid PsycINFO, Web of Science, and International trial registries, up to May 2015, for RCTs including adults with CMHDs, in which PROM scores were fed back to the clinician +/- the patient. Two authors independently assessed trial quality and extracted data. We contacted study authors for additional information.

Findings

Seventeen studies involving 8787 participants were included, 2 in primary care, 6 in psychological therapy, and 9 in mental health care settings. Meta-analysis of 12 studies using the Outcome Questionnaire (OQ-45) or Outcome Rating System (ORS) PROMs found no significant difference in outcome between feedback and non-feedback groups (standardised mean difference (SMD) -0.07, 95% confidence interval (C.I.) -0.16 to 0.01); low quality evidence. A post-hoc analysis of 10 studies which identified participants who were considered early in treatment to be 'on track' (OT) or 'not on track' (NOT) for a good outcome found a statistically significant effect favouring the use of PROMs in the NOT participants only (SMD = -0.22, 95% CI -0.35 to -0.09). A post-hoc analysis of 4 studies reporting differences in the amount of treatment required found evidence favouring feedback for OT participants only (mean difference -0.69 sessions, 95% CI -1.10 to -0.29).

Consequences

We found low quality evidence that routine outcome monitoring may be beneficial in terms of improving outcomes for patients identified as 'not on track' for a good outcome early in treatment, and in terms of reducing the number of treatment sessions required for patients identified as 'on track'. However, more research of better quality is required, especially in primary care where most CMHDs are managed.

Submitted by: 
Tony Kendrick
Funding acknowledgement: 
Cochrane Depression, Anxiety and Neuroses group