Langley Paul C
College of Pharmacy, University of Minnesota.
Innov Pharm. 2019 Aug 31;10(2). doi: 10.24926/iip.v10i2.1782. eCollection 2019.
Previous commentaries in the Formulary Evaluation section of INNOVATIONS in Pharmacy have pointed to the difficulties of establishing the credibility of trial-based and modeled claims for therapy interventions. Claims for interventions in behavioral health are no exception. A recent report by The Kennedy Forum emphasizes the need for a system of measurement-based care using validated scales to assess the need for and response to therapy. To accomplish this, The Kennedy Forum proposed a core set of outcomes measures for behavioral health interventions. This core set provides the context for a proposed Behavioral Health Management Registry (BHMR). The purpose of this commentary is to describe the structure and content of the BHMR. The BHMR provides access to nine symptom rating scales for depression, mania, anxiety, PTSD, panic attacks, alcohol use, drug abuse and somatization, together with supplementary questions to capture socio-demographic characteristics of patients, pain experience and opioid use, medical marijuana, DSM-V criteria for PTSD diagnosis and sleep experience. As such, with patient and physician inputs over the course of treatment, the BHMR provides an evidence base for physician practices and health care decision makers to evaluate behavioral health interventions by tracking the cumulative response to therapy. In addition, the BHMR captures the perception of the patients as to whether or not their therapy has led to any substantive improvement in activity limitations, symptoms and quality of life. A particular focus of the BHMR is on monitoring and evaluating the impact of interventions on the overall experience of pain as well as tracking pain intensity and functional status by body location. This is important given the prevalence of pain and its association with conditions such as depression and anxiety. The BHMR can also support monthly reports to the practice to summarize patient throughput, the response to care by target pain patients and profiles of opioid use and abuse. The BHMR can be customized to meet the needs of individual practices.
《药学创新》“处方集评估”板块之前的评论指出，确立基于试验和模型的治疗干预主张的可信度存在困难。行为健康干预的主张也不例外。肯尼迪论坛最近的一份报告强调，需要一个基于测量的护理系统，使用经过验证的量表来评估治疗需求和治疗反应。为实现这一目标，肯尼迪论坛提出了一套行为健康干预的核心结局指标。这套核心指标为拟议的行为健康管理登记处（BHMR）提供了背景。本评论的目的是描述BHMR的结构和内容。BHMR提供了九种症状评定量表，用于评估抑郁、躁狂、焦虑、创伤后应激障碍（PTSD）、惊恐发作、酒精使用、药物滥用和躯体化症状，同时还有补充问题，以获取患者的社会人口学特征、疼痛经历和阿片类药物使用情况、医用大麻、PTSD诊断的《精神疾病诊断与统计手册》第五版（DSM-V）标准以及睡眠经历。因此，在治疗过程中，通过患者和医生的输入，BHMR为医生的诊疗实践和医疗保健决策者提供了一个证据基础，以便通过跟踪对治疗的累积反应来评估行为健康干预措施。此外，BHMR还记录了患者对其治疗是否在活动受限、症状和生活质量方面带来任何实质性改善的看法。BHMR的一个特别重点是监测和评估干预措施对整体疼痛体验的影响，以及按身体部位跟踪疼痛强度和功能状态。鉴于疼痛的普遍性及其与抑郁和焦虑等疾病的关联，这一点很重要。BHMR还可以支持向诊疗机构提供月度报告，以总结患者流量、目标疼痛患者的护理反应以及阿片类药物使用和滥用情况。BHMR可以进行定制，以满足个别诊疗机构的需求。
