Abstract
This paper describes the development and use of the Medication Recommendation Tracking Form (MRTF), a novel method for capturing physician prescribing behavior and clinical decision making. The Bipolar Trials Network developed and implemented the MRTF in a comparative effectiveness study for bipolar disorder (LiTMUS). The MRTF was used to assess the frequency, types, and reasons for medication adjustments. Changes in treatment were operationalized by the metric Necessary Clinical Adjustments (NCA), defined as medication adjustments to reduce symptoms, optimize treatment response and functioning, or to address intolerable side effects. Randomized treatment groups did not differ in rates of NCAs, however, responders had significantly fewer NCAs than non-responders. Patients who had more NCAs during their previous visit had significantly lower odds of responding at the current visit. For each one-unit increase in previous CGI-BP depression score and CGI-BP overall severity score, patients had an increased NCA rate of 13% and 15%, respectively at the present visit. Ten-unit increases in previous Montgomery Asberg Depression Rating Scale (MADRS) and Young Mania Rating Scale (YMRS) scores resulted in an 18% and 14% increase in rates of NCAs, respectively. Patients with fewer NCAs had increased quality of life and decreased functional impairment. The MRTF standardizes the reporting and rationale for medication adjustments and provides an innovative metric for clinical effectiveness. As the first tool in psychiatry to track the types and reasons for medication changes, it has important implications for training new clinicians and examining clinical decision making. (ClinicalTrials.gov number NCT00667745).
| Original language | English (US) |
|---|---|
| Pages (from-to) | 1686-1693 |
| Number of pages | 8 |
| Journal | Journal of Psychiatric Research |
| Volume | 47 |
| Issue number | 11 |
| DOIs | |
| State | Published - Nov 2013 |
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Keywords
- Bipolar disorder
- Comparative effectiveness research
- Medication algorithms
- Medication tracking
ASJC Scopus subject areas
- Psychiatry and Mental health
- Biological Psychiatry
- Arts and Humanities (miscellaneous)
Cite this
The Medication Recommendation Tracking Form : A novel tool for tracking changes in prescribed medication, clinical decision making, and use in comparative effectiveness research. / Reilly-Harrington, Noreen A.; Sylvia, Louisa G.; Leon, Andrew C.; Shesler, Leah W.; Ketter, Terence A.; Bowden, Charles L.; Calabrese, Joseph R.; Friedman, Edward S.; Ostacher, Michael J.; Iosifescu, Dan V.; Rabideau, Dustin J.; Thase, Michael E.; Nierenberg, Andrew A.
In: Journal of Psychiatric Research, Vol. 47, No. 11, 11.2013, p. 1686-1693.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - The Medication Recommendation Tracking Form
T2 - A novel tool for tracking changes in prescribed medication, clinical decision making, and use in comparative effectiveness research
AU - Reilly-Harrington, Noreen A.
AU - Sylvia, Louisa G.
AU - Leon, Andrew C.
AU - Shesler, Leah W.
AU - Ketter, Terence A.
AU - Bowden, Charles L.
AU - Calabrese, Joseph R.
AU - Friedman, Edward S.
AU - Ostacher, Michael J.
AU - Iosifescu, Dan V.
AU - Rabideau, Dustin J.
AU - Thase, Michael E.
AU - Nierenberg, Andrew A.
PY - 2013/11
Y1 - 2013/11
N2 - This paper describes the development and use of the Medication Recommendation Tracking Form (MRTF), a novel method for capturing physician prescribing behavior and clinical decision making. The Bipolar Trials Network developed and implemented the MRTF in a comparative effectiveness study for bipolar disorder (LiTMUS). The MRTF was used to assess the frequency, types, and reasons for medication adjustments. Changes in treatment were operationalized by the metric Necessary Clinical Adjustments (NCA), defined as medication adjustments to reduce symptoms, optimize treatment response and functioning, or to address intolerable side effects. Randomized treatment groups did not differ in rates of NCAs, however, responders had significantly fewer NCAs than non-responders. Patients who had more NCAs during their previous visit had significantly lower odds of responding at the current visit. For each one-unit increase in previous CGI-BP depression score and CGI-BP overall severity score, patients had an increased NCA rate of 13% and 15%, respectively at the present visit. Ten-unit increases in previous Montgomery Asberg Depression Rating Scale (MADRS) and Young Mania Rating Scale (YMRS) scores resulted in an 18% and 14% increase in rates of NCAs, respectively. Patients with fewer NCAs had increased quality of life and decreased functional impairment. The MRTF standardizes the reporting and rationale for medication adjustments and provides an innovative metric for clinical effectiveness. As the first tool in psychiatry to track the types and reasons for medication changes, it has important implications for training new clinicians and examining clinical decision making. (ClinicalTrials.gov number NCT00667745).
AB - This paper describes the development and use of the Medication Recommendation Tracking Form (MRTF), a novel method for capturing physician prescribing behavior and clinical decision making. The Bipolar Trials Network developed and implemented the MRTF in a comparative effectiveness study for bipolar disorder (LiTMUS). The MRTF was used to assess the frequency, types, and reasons for medication adjustments. Changes in treatment were operationalized by the metric Necessary Clinical Adjustments (NCA), defined as medication adjustments to reduce symptoms, optimize treatment response and functioning, or to address intolerable side effects. Randomized treatment groups did not differ in rates of NCAs, however, responders had significantly fewer NCAs than non-responders. Patients who had more NCAs during their previous visit had significantly lower odds of responding at the current visit. For each one-unit increase in previous CGI-BP depression score and CGI-BP overall severity score, patients had an increased NCA rate of 13% and 15%, respectively at the present visit. Ten-unit increases in previous Montgomery Asberg Depression Rating Scale (MADRS) and Young Mania Rating Scale (YMRS) scores resulted in an 18% and 14% increase in rates of NCAs, respectively. Patients with fewer NCAs had increased quality of life and decreased functional impairment. The MRTF standardizes the reporting and rationale for medication adjustments and provides an innovative metric for clinical effectiveness. As the first tool in psychiatry to track the types and reasons for medication changes, it has important implications for training new clinicians and examining clinical decision making. (ClinicalTrials.gov number NCT00667745).
KW - Bipolar disorder
KW - Comparative effectiveness research
KW - Medication algorithms
KW - Medication tracking
UR - http://www.scopus.com/inward/record.url?scp=84884418749&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84884418749&partnerID=8YFLogxK
U2 - 10.1016/j.jpsychires.2013.07.009
DO - 10.1016/j.jpsychires.2013.07.009
M3 - Article
VL - 47
SP - 1686
EP - 1693
JO - Journal of Psychiatric Research
JF - Journal of Psychiatric Research
SN - 0022-3956
IS - 11
ER -