There’s a ton of potential quality and financial return in streamlining the mental healthcare process, but we need to get more precise to do so.
COVID-19 has radically affected mental health, with the number of people with depression symptoms triple what they were before the start of the pandemic. As we think about how to improve the accessibility and quality of care over the next decade, now is an important inflection point for us to integrate better, more data-driven tools to drive improved outcomes.
One reason we haven’t been able to significantly change outcomes is a lack of precision in monitoring and medication management. Without monitoring, we are missing out on a 20-60% boost in clinical outcomes by not leveraging data and software to track a patient’s progress. Some leading platforms are doing this. A similar deficit in quality medication management can lead to a patient not adhering to their medication plan, which can lead to worse outcomes. Long story short, there’s a ton of potential quality and financial return in streamlining the mental healthcare process, but we need to get more precise to do so.
“This lack of precision has led to a ‘cycle of trial and error’, in which patients might ‘wait as long as several weeks to kick in, and then may not have an adequate response, so they will be switched to a different drug and have to repeat the same process,” says Dr. Madukhar Trivedi, leading precision medicine advocate from the UT Southwestern Medical Center.
As Trivedi indicates, mental health outcomes should involve less of a gamble. A new macrotrend in “data-driven care” has arisen across the mental health landscape, with research and innovation dedicated toward rethinking mental healthcare. I believe this macrotrend is the future of mental health care.
Measurement-based care (MBC) refers to a systematic and evidence-based method of monitoring a patient’s progress through their treatment journey. Guided by data, clinicians can make objective and informed decisions. Unlike primary care, where quantitative assessments like blood pressure have been routinely monitored for years, this is challenging for the mental health field.
In psychiatry, MBC involves routinely administering validated assessments to patients to measure their progress. Clinicians may measure symptom severity, quality of life, functioning, and treatment feedback in real-time. Research has shown that continuous monitoring and feedback results in significant improvements in outcomes, nearly doubling therapeutic effect size.
MBC is impactful because it allows clinicians to recognize poor response to treatment and change trajectory. Assessment results are made visible to both patient and clinician, thereby engaging the patient in their own healthcare decisions.
Without MBC, clinicians can only detect deterioration in about 20% of patients. Without systematic feedback, as many as 80% of depression patients still present with symptoms a year later. With MBC, clinicians will be able to make better decisions throughout the treatment process.
Personalizing treatment decisions is essential considering 1/3 of people with depression are treatment-resistant, meaning they have tried at least one adequately dosed medication and haven’t seen meaningful clinical improvement. Precision psychiatry empowers clinicians with the data to personalize care.
Precision psychiatry is a new field in mental health that uses the aggregate of data to make objective and informed decisions about individual patients rather than patients “on average.” It aims to leverage big data and meta-analyses to use genetic biomarkers, brain imaging, and other validated assessments to guide clinicians in choosing the most appropriate therapeutic option.
In the Real World
So, what do MBC and precision psychiatry actually look like in the real world, and are people benefiting from it?
MBC is now in the process of being incorporated into large organizations like the Veteran’s Affairs (VA), the American Psychiatric Association, and the Joint Commission, an accrediting agency for healthcare organizations.
A number of telehealth and health IT companies have now developed software and technology to help build evidence-based infrastructure for monitoring patient progress. Osmind, for example, built a psychiatric electronic health record (EHR) specifically for practices serving treatment-resistant mental health patients. The goal is to be able to track and analyze outcomes at a granular level, thereby offering patients and clinicians near real-time insights into patient progress and increasing patient engagement with the care process.
“We at Osmind believe that mental health is on the verge of a renaissance so that patients can finally get effective, personalized treatments,” said Lucia Huang, co-founder and CEO of Osmind. “We are furthering this goal by building the digital infrastructure for next-gen mental health, including software that improves care delivery through the use of measurement-based care, and analytics to help with the development and delivery of better mental health therapies.”
On the other side of the coin, mental healthcare providers themselves are seeing a number of data-driven concepts in the pipeline to give their members a better shot at benefiting from treatment and a better understanding of how their biology might interact with their care. For example, researchers have been able to associate inflammatory biomarkers, such as C-reactive protein (CRP) with outcomes. Early evidence suggests that baseline levels of CRP might influence antidepressant selection and response. There’s also recent evidence that suggests that exercise has a greater effect than medication in alleviating depression symptoms in patients with higher levels of an inflammatory biomarker, TNF-α.
For example, Prairie Health’s service for people with depression and anxiety includes genetic testing, which is meant to identify gene variants that may influence a person’s response to medication. Research indicates that nearly 90% of people have at least one variant that could impact their response, a driver behind Prairie’s desire to tailor mental healthcare for the individual.
“Prairie Health’s mission is to use research and technology to empower everyone to achieve better mental health,” Prairie Health CEO Maurice Chiang said. “Our belief is that the future of psychiatry will look more data-driven–we’ll be using genetics data, phenotypic data, and better metrics to track outcomes to improve the quality of care.”
Chiang indicates that the level of precision that physical healthcare providers use to manage and care for their patients should be similarly utilized by mental healthcare providers. It has historically been challenging to accurately measure outcomes in psychiatry, but improvements in technology and science have helped pave the way.
The Potential of Data-Driven Care
Precision psychiatry and measurement base care are still in their early stages and more research still needs to be done, but as we continue to incorporate these models into mental healthcare, we can change this field for the better.
Data-driven mental healthcare is the future. With precision psychiatry and measurement-based care, we will pave the way for more accurate diagnoses and more effective therapies — ultimately supporting what’s most important: patients feeling better sooner.
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Wed Sep 08 2021