This is the third in a series of articles from Dr. McInnes on how clinicians can implement measurement-based care into their daily practice. The first article, “How to use measurement-based care to achieve better outcomes for patients with treatment-resistant depression,” can be read here. The second article, “Increasing patient engagement and retention during ketamine infusion therapy,” can be read here.

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Busy clinicians often wonder how they can manage seeing patients in office and coordinate all of the inter-visit support, while also helping patients become more involved in their own care.

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This was the exact challenge that my colleague, psychiatrist Dr. Carlene MacMillan, and I sought to address as we play dual roles on the executive leadership team at Osmind while continuing to see patients for breakthrough mental health treatments.

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We help drive product decisions behind the Osmind EHR and novel features that allow clinicians to efficiently blend measurement-based care (MBC) into their daily practice.

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What is measurement-based care?

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Measurement-based care is an evidence-based practice that refers to the systematic evaluation of patient progress throughout a treatment, including routine administration of symptom rating scales, which helps drive clinical decision-making in a personalized manner.

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Evidence has shown that MBC improves clinical outcomes, therapeutic efficiency, and patient adherence. As a result, patients feel more engaged and informed. They are also more in tune with their own progress and can recognize early signs of relapse or promising signs of improvement. Finally, patients find that this approach democratizes the relationship with the provider and enhances overall communication.

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How is measurement-based care used in interventional psychiatry?

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There is a large body of evidence that not only supports MBC, but observes that mental health patients find it helpful as well. MBC helps patients to:

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• Better understand their own condition and be more in tune with their own progress to recognize early signs of relapse or promising signs of improvement. This helps them stay engaged throughout their care journey.

• Adhere to medication and treatment protocols by giving patients a sense of control over their treatment process. MBC reinforces their motivation by adding efficiency to the care journey. In fact, many practices have reported that MBC reduces no-shows at appointments.

• Enhance the therapeutic relationship with their clinician – patients see MBC as evidence that clinicians care about them and study after study has found that it fosters better communication that further increases engagement.

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Here are four simple ways that the Osmind EHR can support busy clinicians in providing patients with the tools to collaborate in their care management.

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1) The Osmind Patient App‍

Aka the central hub where patients can track their progress and communicate with clinicians in between appointments. It enhances patient care by facilitating easier communication with their clinic, helps track medications and other parts of the treatment plan, and allows individuals to submit out-of-network insurance claims for treatments in a free and streamlined fashion.

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On the clinician side, it is a pragmatic platform for preparation and integration, offering three opportunities for patient engagement via administration of mood surveys, a journaling feature, and support via the patient community.

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The app asks patients to track how they're doing between visits, using validated survey questionnaires and mood scores for daily assessments so they know their clinicians are really aware of how they are feeling during the critical induction period and beyond.

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Patients receive notifications and text messages to remind them to complete these measures, which allow both clinician and patient to more effectively track progress together. Notably, clinicians can see which interventions are working in real-time and adjust the treatment plan accordingly.

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2) Mood Surveys

Before the induction, we need to administer validated mood surveys to the patient in order to identify particularly problematic symptoms and document a careful assessment of suicidal ideation.

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The clinician and the patient can then discuss what a meaningful reduction of symptoms would look like (does not have to be the 50% reduction of symptoms used in academia, but rather something the clinician and patient decide as a duo) and when these symptoms will next be assessed.

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As most patient-reported mood surveys are only meaningful in 1-2 week intervals, you can also request that your patients provide daily mood scores which constitute important data between infusions. Many patients don’t respond to the first one or two ketamine infusions and it’s important to reach out and provide support if that is the case so patients are less likely to leave treatment before they achieve clinical improvement.

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‍Osmind has an extensive survey library of >30 patient reported and clinically administered surveys, so clinicians can better evaluate patients and understand how they are responding to treatments.

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To date, over 19,000 patients in the Osmind community have completed at least one survey on the Osmind Patient App and more than 1 million mood measures have been collected. This de-identified dataset helps patients see how they are doing and enables important real-world studies like Osmind Real-World Ketamine Analyses (ORKA) that demonstrate to stakeholders like payers that interventions are helping and should receive insurance coverage.

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3) Journaling

The journaling feature of the Osmind EHR is well-designed for integration. Encouraging patients to use it, if only for the induction, creates an opportunity to intervene if individuals are feeling discouraged. Patients may be more frank about their experience when journaling and clinicians may also identify doubts and concerns that a patient might forget to voice in session.

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The clinician can then provide active support with reminders about the treatment plan, recommended reading, and healthful practices that can sustain the patient and get them back for another visit.

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This collaborative MBC-based approach improves the likelihood that patients who might ultimately benefit from KIT will stick with it, and that those who don’t respond will still feel deeply cared for by their clinicians and seen as equal partners in the treatment process (Dowrick et al. 2009). Nearly 10,000 patients in the Osmind community have created a journal entry.

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4) Osmind Patient Community‍

You can direct patients to the Osmind patient community, a forum where patients can get feedback and peer support from fellow patients.

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Patient support groups have been shown to drive empowerment, health literacy, and adherence–making it a valuable adjunct tool for clinicians to promote retention and engagement outside of treatment sessions.

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The Osmind Patient Community is a safe space for people who have depression and/or other mental health issues and those who are interested in mental health care, psychedelic medicine, brain stimulation, and other innovative treatments for mental health disorders. Since launching, the Patient Community has supported >1,400 patients.

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The community promotes information-sharing between patients, connects patients with local resources in each region, facilitates knowledge-building through conversations with mental health experts, and offers patients the opportunity to be part of groundbreaking research like clinical trial opportunities. Patients routinely ask each other questions like, “How do I know this is working?” and sustain each other with valuable experience and compassion.

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Summary:

Theres no doubt that having an informed, engaged patient who can participate in shared decision-making is powerful.

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At Osmind, we think of mood surveys and journaling as vital signs that are essential for both the provision of excellent care and the success of your clinic.

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The information you derive from these data will lead to increased patient retention and better outcomes at the level of the individual patient. 

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Further, you can use MBC tools to empower patients. With a two-way line of communication and progress-tracking, and a supportive patient community, they'll feel agency and ongoing support, even when they're not in the clinic with you.

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About Dr. L. Alison McInnes

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Dr. L. Alison McInnes is Vice President, Medical Affairs at Osmind. She is a nationally recognized expert in psychiatry and mood and anxiety disorders, having specialized in treating refractory disease for over a decade. She is an expert in ketamine treatment and psychedelic medicine. McInnes founded and served as Medical Director for Kaiser Permanente's ketamine infusion therapy program for a number of years, and was previously an Associate Professor of Psychiatry at Mount Sinai School of Medicine for 8 years where she ran a lab in psychiatric genetics. She was also an adjunct clinical professor at UCSF.

Dr. McInnes is regularly invited to speak at national and international conferences and consults for biopharmaceutical companies working at the cutting edge of neuropsychiatry. She is a member of the American Society of Ketamine Physicians, Psychotherapists and Practitioners (ASKP3) Certification Governance Commission, which is an autonomous governing body that oversees the development, implementation, and management of a certification program for clinicians offering ketamine therapy. In her current clinical practice, she focuses on treatment-resistant mood disorders and complex cases.

Dr. McInnes received Bachelor’s and Master’s degrees from Stanford University and her MD from Columbia University. She completed her residency at UCSF and research at the VA Research Fellowship and Howard Hughes Physician Research Fellowship in Psychiatric Genetics at UCSF.

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