Timely Adjustment of Treatment: When and How do We Stop or Change our Treatment Approach?
Introduction
In specialized mental healthcare a group of patients does not recover well, despite prolonged periods of intensive specialized mental health care. In order to prevent long-term treatment stagnation in this group, the project ‘Timely Adjustment of Treatment’ was started in 18 specialized mental health-care teams. Goal of this project was to overcome stagnation by identifying those individuals at risk of treatment stagnation and offer periodic assistance to the treatment team of selected patients by an external expert.
Methods
Mental health-care professionals identified several indicators that could point at treatment stagnation in patients receiving care for more than 2 years. These include:
- lack of improvement on measures of symptomatic, societal and/or personal recovery
- treatment coordination meetings between professionals more often than once a month during the last year
- frequent patient – therapist contact ( > 25 hours in the last year)
- one or more inpatient admissions
- polypharmacy (>= 3 pharmaceutical interventions)
A dashboard was developed to present information about patients with three or more treatment-stagnation indicators. Teams were encouraged to select patients for which they needed external consultation, often resulting in recovery-oriented diagnostics, treatment adjustment or a treatment closure process. Furthermore, all professionals were trained in how to complete treatments and gained insight into which patient, therapist and organizational factors contributed to their decisions to stop or continue treatments.
Results and discussion
During this project both subjective outcome measures, including professional attitude regarding treatment completion and adjustment, as well as objective measures, including the number of stagnated treatments, were monitored. These preliminary project-evaluation results will be shown and discussed. A secondary gain of this project was that teams also gained insight into patients showing a stable recovery process which may facilitate the discussion to determine the right time to complete individual treatments.
In specialized mental healthcare a group of patients does not recover well, despite prolonged periods of intensive specialized mental health care. In order to prevent long-term treatment stagnation in this group, the project ‘Timely Adjustment of Treatment’ was started in 18 specialized mental health-care teams. Goal of this project was to overcome stagnation by identifying those individuals at risk of treatment stagnation and offer periodic assistance to the treatment team of selected patients by an external expert.
Methods
Mental health-care professionals identified several indicators that could point at treatment stagnation in patients receiving care for more than 2 years. These include:
- lack of improvement on measures of symptomatic, societal and/or personal recovery
- treatment coordination meetings between professionals more often than once a month during the last year
- frequent patient – therapist contact ( > 25 hours in the last year)
- one or more inpatient admissions
- polypharmacy (>= 3 pharmaceutical interventions)
A dashboard was developed to present information about patients with three or more treatment-stagnation indicators. Teams were encouraged to select patients for which they needed external consultation, often resulting in recovery-oriented diagnostics, treatment adjustment or a treatment closure process. Furthermore, all professionals were trained in how to complete treatments and gained insight into which patient, therapist and organizational factors contributed to their decisions to stop or continue treatments.
Results and discussion
During this project both subjective outcome measures, including professional attitude regarding treatment completion and adjustment, as well as objective measures, including the number of stagnated treatments, were monitored. These preliminary project-evaluation results will be shown and discussed. A secondary gain of this project was that teams also gained insight into patients showing a stable recovery process which may facilitate the discussion to determine the right time to complete individual treatments.