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RESEARCH WEEKLY: Provider Barriers to Measurement-Based Care
By Hope Parker
(August 9, 2023) Despite both the American Psychological Association and SMI Adviser promoting the use of measurement-based care (MBC) in mental health care, very little research has examined the reasons why many providers have not yet incorporated MBC into their treatment plans. Patients with severe mental illness would especially benefit from MBC, as it would allow providers to track symptom changes and improvement over a long period of time and to quickly inform new providers of the patients’ symptom history.
What is measurement-based care?
MBC is the practice of using clinical measurement instruments to measure symptoms, treatment progress, and patient outcomes over time. It allows providers to quantitatively evaluate feedback from their patients and utilize that data to guide their patient’s individual treatment plan. Scales have been developed to measure many aspects of mental health, such as depression, anxiety, recovery, stigma, and well-being.
Research has shown that MBC is effective at improving patient outcomes, especially for patients whose symptoms took longer to improve, as well as for identifying when a patient begins to deteriorate. Research has also indicated that it helps improve relationships between patients and providers and creates more collaborative care within treatment teams.
Methods
A study published earlier this year in “Psychiatric Services” sought to understand what barriers mental and substance use treatment providers face to implementing MBC in their practice. Researchers distributed a survey to 5,000 mental health and substance use treatment providers in North Carolina that asked questions about demographic data, practice location, clinical practice characteristics, and provider characteristics. A 16-item questionnaire was also included and asked providers about barriers to implementing MBC, including perceived clinical utility of MBC, their knowledge of and ability to implement MBC, the administrative burden of MBC, and their concerns about the use of data collected.
Key findings
The survey received 922 eligible responses. Of those respondents, the majority were female (79%), white (72%), and master’s level providers (80%) who practiced for an average of 25 hours a week.
Less than half of providers use MBC with their patients often, despite robust evidence that it improves patient outcomes. Administrative burdens and the belief that MBC has low clinical utility were the factors associated with the decreased use of MBC. While some providers didn't believe that MBC was useful, most providers felt as though they had the knowledge and ability to implement MBC. Because of this, initiatives that aim to address provider concerns over the utility of MBC may be more successful in increasing MBC use as opposed to trainings that address knowledge gaps.
Training in MBC is the factor that most strongly predicts a provider using it in their practice. The researchers note that this may be because providers who value MBC are more likely to seek out additional training. Large or facility-based practices were also more likely to implement MBC, potentially because larger practices may have more administrative staff and infrastructure to support the use of MBC.
As a part of the survey, providers were presented with a list of statements and were asked to rate on a 1-5 scale how much they agreed or disagreed with them.
Most providers agreed or strongly agreed with the following statements:
- MBC is useful for tracking symptoms (60%).
- Research supports the use of MBC (54%).
- Providers are not compensated for MBC (53%).
- MBC is useful for making treatment decisions (50%).
Most providers disagreed or strongly disagreed with the following statements:
- “I don’t know what MBC is” (80%).
- “I have trouble interpreting the results” (72%).
- “I don’t know how to use MBC in my practice” (70%).
- “I don’t have an electronic record or platform to collect these results” (55%).
- “I don’t think standardized measures are useful” (53%).
Providers provided mixed responses to the following statements:
- Current measures do not suit patients’ needs and complexity: 42% of providers disagreed, while 34% agreed.
- MBC is too time-consuming: 33% of providers disagreed, while 35% agreed.
- Trouble incorporating MBC into workflow: 39% disagreed, while 35% agreed.
- Concern that patients will not complete measures: 34% disagreed, while 43% agreed.
Provider concerns about implementing MBC:
Providers were most concerned that the data they collected from their patients would be used to negatively evaluate their performance as clinicians. The second-biggest concern providers had about using MBC was the administrative burden, followed by providers not believing MBC would be useful in clinical care. The fewest providers had concerns over whether they had the knowledge and ability to implement MBC.
Despite most providers raising concern over data usage, it did not appear to actually be associated with decreased implementation of MBC. Providers were least likely to utilize MBC if they held the belief that it would not be a useful tool to help their patients.
Implications for SMI
The implementation of MBC could be especially helpful in tracking treatment for individuals with severe mental illness, who often need ongoing mental health care. MBC has the capacity to detect symptom changes and deterioration early, so that patients with SMI can have their treatment plans changed if needed. It could also potentially help providers see trends in the symptoms of SMI over time, so that providers can better track what is most helpful to their patient’s recovery.
References
Aboraya, A. et al. (2018). Measurement-based Care in Psychiatry-Past, Present, and Future. Innovations in Clinical Neuroscience.
Fortney, J. C. et al. (2017). A tipping point for measurement-based care. Psychiatric Services.
Keepers, B.C. et al. (January 2023). A Survey of Behavioral Health Care Providers on Use and Barriers to Use of Measurement-Based Care. Psychiatric Services.
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