Beyond Efficacy and Effectiveness: Clinical Efficiency Is Necessary for Dissemination

2021 ◽  
Vol 35 (3) ◽  
pp. 221-231
Author(s):  
Alessandro S. De Nadai ◽  
Joseph L. Etherton
Keyword(s):  
Stepped Care ◽  
Insurance Companies ◽  
Evidence Based ◽  
Efficiency Ratio ◽  
Low Intensity ◽  
Clinical Efficiency ◽  
Referral Decisions ◽  
New Perspective ◽  
Evidence Based Care ◽  
Widespread Dissemination

Nearly all patients interact with critical gatekeepers—insurance companies or centralized healthcare systems. For mental health dissemination efforts to be successful, these gatekeepers must refer patients to evidence-based care. To make these referral decisions, they require evidence about the amount of resources expended to achieve therapeutic gains. Without this information, a bottleneck to widespread dissemination of evidence-based care will remain. To address this need for information, we introduce a new perspective, clinical efficiency. This approach directly ties resource usage to clinical outcomes. We highlight how cost-effectiveness approaches and other strategies can address clinical efficiency, and we also introduce a related new metric, the incremental time efficiency ratio (ITER). The ITER is particularly useful for quantifying the benefits of low-intensity and concentrated interventions, as well as stepped-care approaches. Given that stakeholders are increasingly requiring information on resource utilization, the ITER is a metric that can be estimated for past and future clinical trials. As a result, the ITER can allow researchers to better communicate desirable aspects of treatment, and an increased focus on clinical efficiency can improve our ability to deliver high-quality treatment to more patients in need.

scholarly journals Innovations in the psychosocial treatment of youth with anxiety disorders: implications for a stepped care approach

2018 ◽  
Vol 21 (3) ◽  
pp. 112-115 ◽  
Author(s):  
Thomas H Ollendick ◽  
Lars-Göran Öst ◽  
Lara J Farrell
Keyword(s):  
Anxiety Disorders ◽  
High Intensity ◽  
Care Delivery ◽  
Psychosocial Interventions ◽  
Psychosocial Treatment ◽  
Stepped Care ◽  
Future Research ◽  
Evidence Based ◽  
Low Intensity ◽  
Care Approach

Anxiety disorders are highly prevalent among children and adolescents and frequently result in impairments across multiple domains of life. While psychosocial interventions, namely cognitive-behavioural therapy (CBT), have been found to be highly effective in treating these conditions, significant numbers of youth simply do not have access to these evidence-based interventions, and of those who do, a substantial proportion (up to 40%) fail to achieve remission. Thus, there is a pressing need for innovation in both the delivery of evidence-based treatments and efforts to enhance treatment outcomes for those who do not respond to standard care. This paper reviews current innovations attempting to address these issues, including evidence for brief, low-intensity approaches to treatment; internet delivered CBT and brief, high-intensity CBT. Moreover, we propose a model of stepped care delivery of evidence-based mental health interventions for children and youth with anxiety. In general, a stepped care approach begins with a lower intensity, evidence-based treatment that entails minimal therapist involvement (ie, brief, low-intensity self-help or internet delivered CBT) and then proceeds to more intensive treatments with greater therapist involvement (ie, brief high-intensity CBT), but only for those individuals who show a poor response at each step along the way. Future research is needed in order to evaluate such a model, and importantly, to identify predictors and moderators of response at each step, in order to inform an evidence-based, fully-integrated stepped care approach to service delivery.

scholarly journals Management of Depression in Patients With Cancer: A Clinical Practice Guideline

2016 ◽  
Vol 12 (8) ◽  
pp. 747-756 ◽  
Author(s):  
Madeline Li ◽  
Erin B. Kennedy ◽  
Nelson Byrne ◽  
Caroline Gérin-Lajoie ◽  
Mark R. Katz ◽  
...  
Keyword(s):  
Clinical Practice ◽  
Systematic Reviews ◽  
Collaborative Care ◽  
Specific Treatment ◽  
Stepped Care ◽  
Evidence Based ◽  
Management Tools ◽  
Patients With Cancer ◽  
Practical Management ◽  
Evidence Based Care

Purpose: This report updates the Cancer Care Ontario Program in Evidence-Based Care guideline for the management of depression in adult patients with cancer. This guideline covers pharmacologic, psychological, and collaborative care interventions, with a focus on integrating practical management tools to assist clinicians in delivering appropriate treatments for depression in patients with cancer. Methods: Recommendations were developed by synthesizing information from extant guidelines and reviews and searching for randomized controlled trials from the date of database inception (1964 for MEDLINE and 1974 for EMBASE) to January 2015. Quality assessment of guidelines and systematic reviews were conducted by using the Appraisal of Guidelines for Research and Evaluation II (AGREE II), Assessment of Multiple Systematic Reviews (AMSTAR), and Cochrane Risk of Bias tools. Final recommendations were developed through a standardized Program in Evidence-Based Care multidisciplinary expert and knowledge user review process. Results: Two high-quality relevant clinical practice guidelines, eight pharmacologic trials, nine psychological trials, and eight collaborative care intervention trials composed the evidence base upon which the recommendations were developed. Eight specific recommendations were made to establish a standard of care for the management of depression in patients with cancer. The recommendations and practical management tools were reviewed as being well organized and helpful, although systemic barriers to implementation were identified. Conclusion: This updated guideline supports the previous general recommendation that patients with cancer who have depression may benefit from psychological and/or pharmacologic interventions, without evidence for the superiority of any specific treatment over another. New recommendations for a collaborative care model that incorporates a stepped care approach suggest that multidisciplinary mental health care restructuring may be required for optimal management of depression.

Factors Associated With Evidence-Based Care in Community-Based Child Psychotherapy

2010 ◽  
Author(s):  
Lauren Brookman-Frazee ◽  
Rachel A. Haine ◽  
Mary J. Baker-Ericzen ◽  
Ann F. Garland
Keyword(s):  
Child Psychotherapy ◽  
Evidence Based ◽  
Community Based ◽  
Factors Associated ◽  
Evidence Based Care

scholarly journals Service Use, Drop-Out Rate and Clinical Outcomes: A Comparison Between High and Low Intensity Treatments in an IAPT Service

2014 ◽  
Vol 42 (6) ◽  
pp. 747-759 ◽  
Author(s):  
Stella W. Y. Chan ◽  
Malcolm Adams
Keyword(s):  
Clinical Outcomes ◽  
High Intensity ◽  
Recovery Rate ◽  
Service Use ◽  
Evaluation Study ◽  
Drop Out ◽  
Stepped Care ◽  
Depression And Anxiety ◽  
Low Intensity ◽  
Drop Out Rate

Background: The IAPT services provide high and low intensity psychological treatments for adults suffering from depression and anxiety disorders using a stepped care model. The latest national evaluation study reported an average recovery rate of 42%. However, this figure varied widely between services, with better outcomes associated with higher “step-up” rates between low and high intensity treatments. Aims: This study aimed to compare the two intensity groups in an IAPT service in Suffolk. Method: This study adopted a between groups design. A sample of 100 service users was randomly selected from the data collected from an IAPT service in Suffolk between May 2008 and February 2011. The treatment outcomes, drop-out rate, and other characteristics were compared between those who received high and low intensity treatments. Results: The high intensity group received, on average, more sessions and contact time. They received more CBT sessions and less guided self-help. There were no group differences in terms of the drop-out and appointment cancellation rates. Analyses on clinical outcomes suggested no group difference but demonstrated an overall recovery rate of 52.6% and significant reduction in both depression and anxiety symptoms. Conclusions: Despite methodological limitations, this study concludes that the service as a whole achieved above-average clinical outcomes. Further research building upon the current study in unpacking the relative strengths and weaknesses for the high and low intensity treatments would be beneficial for service delivery.

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