Focussing on quality of life in treatment

Abstract

There are widespread calls for the implementation of outcomes management in mental health services, which involves routinely assessing individual patient outcomes to analyse the effectiveness of treatment. The emphasis in outcomes management is on aggregating outcome data on the level of groups and services and feeding the results back to commissioners, clinicians and managers to inform their decisions on service development and funding. The most important outcome criterion in mental health service research is quality of life, which is also the 'centrepiece' of outcomes management. In several countries, there are plans to implement the main component of outcomes management, i.e. routine outcome assessment, requiring clinicians to routinely assess patient outcome. However, valid data will only be collected if it is worthwhile for clinicians and patients at the level on which it is collected, i.e. the individual patient level. Concurrent assessment and feedback of outcome data to the clinician and patient so that the information can be used to inform treatment activities might make it worthwhile. A European multi-centre randomized controlled trial is currently underway to test the effect of such an intervention in the treatment of psychotic illness. Keyworkers will systematically elicit patients' views on their quality of life, treatment satisfaction and needs for additional/different care over 1 year. It is hypothesized that the intervention will improve patient outcome by prompting explicit discussion about reasons for progress--and lack of progress--in treatment as a basis for further treatment decisions. If the intervention is effective, it is hypothesized that the effect will be mediated by more appropriate treatment decisions and/or a better therapeutic relationship. Focussing on the patient's perspective in the therapeutic interaction may also facilitate patient involvement in decision-making. Finally, outcomes management is still a technical term, which could benefit from further specification and development in order to exploit its potential for improving treatment processes in mental health care.