The effect of implementing the Outcome Questionnaire-45.2 feedback system in Norway: A multisite randomized clinical trial in a naturalistic setting

Abstract

It has been claimed that the monitoring of ongoing psychotherapy is of crucial importance for improving the quality of mental health care. This study investigated the effect of using the Norwegian version of the patient feedback system OQ®-Analyst using the Outcome Questionnaire-45.2. Patients from six psychiatric clinics in Southern Norway (N = 259) were randomized to feedback (FB) or no feedback (NFB). The main effect of feedback was statistical significant (p = .027), corroborating the hypothesis that feedback would improve the quality of services, although the size of the effect was small to moderate (d = 0.32). The benefits of feedback have to be considered against the costs of implementation.

Si ritiene che il monitoraggio della psicoterapia in corso sia di fondamentale importanza per migliorare la qualità dell'assistenza psichiatrica. Questo studio ha esaminato l'effetto dell'utilizzo della versione norvegese del sistema di feedback del paziente OQ®-Analist utilizzando il Outcome Questionnaire-45.2. Pazienti provenienti da sei cliniche psichiatriche della Norvegia meridionale (N=259) sono stati suddivisi in modo randomizzato in due gruppi, feedback (FB) e non feedback (NFB). L'effetto principale del feedback è stato statisticamente significativo (p=0,027), confermando l'ipotesi che il feedback migliorerebbe la qualità dei servizi, anche se l'effect size era compreso tra basso e moderato (d=0,32). Si devono considerare i vantaggi del feedback rispetto ai costi di realizzazione.

Zusammenfassung: Es wurde argumentiert, dass das Monitoring von laufenden Psychotherapien für die Verbesserung der Qualität der psychiatrischen Gesundheitsversorgung von entscheidender Bedeutung ist. Diese Studie untersuchte den Anwendungseffekt der norwegischen Version des Patienten-Feedbacksystems OQ-Analyst unter Verwendung des Outcome Questionnaire-45.2. Patienten von sechs psychiatrischen Kliniken im südlichen Norwegen (N=259) wurden randomisiert einer Feedback (FB) oder Kein-Feedback-Gruppe (NFB) zugeteilt. Der Haupteffekt des Feedbacks war statistisch signifikant (p=.027), was die Hypothese, dass Feedback die Servicequalität verbessere, unterstützt, obwohl die Effektgröße nur klein bis moderat war (d=0.32). Die Vorteile des Feedbacks werden gegen die Kosten ihrer Implementierung abgewogen.

A investigação alega que a monitorização de uma psicoterapia contínua é de crucial importância para melhorar a qualidade dos cuidados de saúde mental. Este estudo investigou o efeito da utilização da versão norueguesa do sistema de feedback do paciente OQ®Analyst, usando o Outcome Questionnaire – 45.2. Os pacientes de seis clínicas psiquiátricas no sul da Noruega (N=259) foram randomizados num de dois grupos: com feedback (FB) ou sem feedback (SFB). O principal efeito do feedback foi estatisticamente significativo (p =.027), corroborando a hipótese de que o feedback iria melhorar a qualidade dos serviços, embora o tamanho do efeito tenha sido de pequeno a moderado (d =.32). Os benefícios do feedback devem ser comparados aos custos de implementação.

摘要

眾所周知檢視正在進行的心理治療對於增進心理健康照護的品質至關重要。本研究調查運用挪威版的效果問卷-45.2病患回饋系統OQ®-分析來檢視效果。來自挪威南部六個心理診所的病患（N=259）被隨機分派到回饋組（FB）或是沒有回饋組（NFB）。結果發現回饋的主要效果有達到統計上的顯著差異（p=.027），支持「回饋可增進服務品質」的假設，不過效果值僅在小到中的程度（d=0.32）。即使有實施成本的考量，回饋帶來的效益仍須列入考慮。

關鍵詞：心理治療的檢視，回饋，效果，效果問卷-45.2，OQ-45

Keywords:

• psychotherapy monitoring
• feedback
• effect
• Outcome Questionnaire-45.2
• OQ-45

Parole chiave:

• monitoraggio della psicoterapia
• feedback
• effetto
• Outcome Questionnaire-45.2
• OQ-45

Schlüsselwörter:

• Psychotherapeutisches Monitoring
• Feedback
• Effekt
• Outcome Questionnaire-45.2
• OQ-45

Notes

1. It could be asserted that feedback would not have an effect by session 2, as no progress has been measured, and therefore patients with only two sessions should be removed. The mechanisms of feedback have not been investigated sufficiently to claim that the patient would not benefit from the participating in feedback, due to the fact, for example, that they are encouraged by a therapist who cares about their progress. As well, previous studies have used patients with two observations (e.g., Hawkins et al., 2004). Nevertheless, we removed the 22 patients who had only two sessions and the results were essentially the same (viz., conclusions about statistical significance did not change for any effect tested).

2. An issue related to clinics is whether the outpatients and inpatients benefited from feedback differently. Because this contrast is not orthogonal from the primary analysis involving clinics, it is not reported here. However, we did conduct the analysis and the results showed no interaction effect of inpatient/outpatient and feedback.

3. We did not perform statistical tests of these proportions because they are redundant with the primary analysis that involved continuously distributed OQ-45 scores.