Psychiatrists Shrink from Outcome Measures in Depression

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Only a small fraction of psychiatrists use validated outcome measures to assess how well depressed patients are doing, a researcher said here.

In a survey of 314 doctors, 60.8% said they never use such outcome measures, according to Mark Zimmerman, M.D., of Brown University in Providence, R.I.

Only 6.8% said they use such scales “nearly all the time,” he said, and another 17.9% said they use them frequently, he told a session at the American Psychiatric Association meeting.

Asked for reasons, 34.3% said they weren’t trained to use them, 33.9% said they take too much of the clinician’s time, and 27.8% said they weren’t clinically helpful, he said. 

Dr. Zimmerman said he and colleagues have developed a self-report outcome measure, the Clinically Useful Depression Outcome Scale (CUDOS), that overcomes most of the objections.

The scale takes less than two minutes to fill out by the patient, he said, with an average patient taking about 103 seconds. It can be scored by the physician in less than 10 seconds, and covers all the DSM-IV symptoms of major depressive disorder, he said.

The researchers reported in Comprehensive Psychiatry earlier this year that the scale had been studied in more than 1,400 psychiatric outpatients and found to have high internal consistency and test-retest reliability.

Scores differed depending on severity of illness, changed as symptoms changed, and were significantly (P<0.001) associated with a diagnosis of major depressive disorder, he said.

The scale also includes measures of psychosocial functioning and quality of life, he added.

The researchers are currently developing an Internet-based version that would allow patients to fill the questionnaire out online and have it emailed to the doctor before an appointment.

Once the bugs are worked out of that process, he said, the CUDOS should "make the clinical encounter more productive" by allowing the physician to see precisely how well a patient is doing and freeing up time for other aspects of care.

"Hopefully, this will be the future," he said.

Dr. Zimmerman added that the electronic CUDOS would be a useful addition as psychiatrists begin to enter the burgeoning field of electronic medical records.

He added that government agencies are beginning to demand more quantifiable data. The Centers for Medicare & Medicaid Services' Physician Quality Reporting Initiative is asking all doctors to collect outcome data and will increase reimbursement if they do so, he said.

The presentation has "great relevance" to clinicians, according to Nitin Gupta, M.D., of the South Staffordshire and Shropshire Health Trust, in England, who moderated the session in which Dr. Zimmerman presented his data.

"Outcome measures are something we struggle with when trying to manage patients with depression," he said. "Having a good outcome scale would be quite useful."

Dr. Nitin said "at a clinical level (in the U.K.) the use of scales is quite low."

But the advance of evidence-based medicine is beginning to change that, he said, because—among other things—such measures allow clinicians to share information more easily.

Outside support for the study was not reported.

Dr. Zimmerman reported no conflicts.

Primary source: American Psychiatric Association Meeting
Source reference:
Zimmerman M, et al “A clinically useful depression outcome scale” APA Meeting 2008; Abstract 69.

Additional source: Comprehensive Psychiatry
Source reference:
Zimmerman M, et al “A clinically useful depression outcome scale” Compr Psychiatry 2008; 49(2): 131-40.

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