In this thesis the effectiveness of concise formats of psycho- and/or pharmacotherapy (concise care) in patients suffering from mild to moderate depressive and anxiety disorders in... Show more In this thesis the effectiveness of concise formats of psycho- and/or pharmacotherapy (concise care) in patients suffering from mild to moderate depressive and anxiety disorders in secondary mental health care is evaluated. A pragmatic randomised controlled equivalence trial was set up and carried out as part of routine clinical practice. Evidence for equivalence of concise care compared with standard care was found. Severity of illness was reduced and general health status and subdomains of quality of life improved in both conditions. Moreover, in concise care, the beneficial effects started earlier and patients were more satisfied with overall treatment than patients in standard care. No significant differences in healthcare costs between both treatments were found. In addition, patients suffering from any anxiety disorder (without comorbid depressive disorder) benefitted less from concise care than from standard care. No other clinical or demographic factors were associated with differential treatment effects. Exploring the agreement between a brief screening questionnaire (the Web Screening Questionnaire (WSQ)), and the gold standard diagnostic interview MINI-Plus, reveals that the WSQ is a good screening tool for depressive and anxiety disorders in clinical practice and it might be a further step in the economization and optimization of mental healthcare. Show less
Objectives Routine Outcome Monitoring (ROM) is an important quality tool for measuring outcome of treatment in health care. The objective of this article is to summarize the evidence base that... Show moreObjectives Routine Outcome Monitoring (ROM) is an important quality tool for measuring outcome of treatment in health care. The objective of this article is to summarize the evidence base that supports the provision of feedback on ROM results to (mental) health care professionals and patients. Also, some relevant theoretical aspects are considered. Methods Literature study (Pubmed, Medline, PsychINFO, Embase Psychiatry, 1975-2009) concerning randomized controlled trials (RTC's) of ROM and feedback on physical or mental health status of patients of all ages. Main search terms were routine outcome monitoring/measurement, feedback, health status measurement, patient reported outcome measures. Results Included were 52 RCT's concerning ROM and feedback with adult or older patients: of these seven RCT's were exclusively focused on physical health and 45 RCT's (also) on the mental health of the patient, although not always in a mental health care setting or as primary outcome measure. There appears to be a positive impact of ROM on diagnosis and monitoring of treatment, and on communication between patient and therapist. Other results were less clear. There were no published RCT's on this topic with children or adolescents. Conclusions ROM appears especially effective for the monitoring of patients who are not doing well in therapy. Further research into this topic and the clinical-and cost-effectiveness of ROM is recommended, especially in mental health care for both adults and children. Also, more theory-driven research is needed with relevant conceptualizations such as Feedback Intervention Theory, Therapeutic Assessment. Show less
