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.
N1 - Funding Information:
Dr. Calabrese receives federal funding from the Department of Defense , Health Resources Services Administration , and NIMH ; he receives research funding or grants from the following private industries or nonprofit funds: Cleveland Foundation , NARSAD , and Stanley Medical Research Institute ; he receives research grants from Abbott, AstraZeneca , Cephalon , GlaxoSmithKline , Janssen , Eli Lilly , and Lundbeck ; he serves on the advisory boards of Abbott, AstraZeneca, Bristol-Myers Squibb, Dainippon Sumitomo Pharma, Forest, France Foundation, GlaxoSmithKline, Janssen, NeuroSearch, OrthoMcNeil, Repligen, Schering-Plough, Servier, Solvay/Wyeth, Takeda, and Supernus Pharmaceuticals; and he reports CME activities with AstraZeneca, Bristol-Myers Squibb, France Foundation, GlaxoSmithKline, Janssen, Johnson & Johnson, Schering-Plough, and Solvay/Wyeth.
Funding Information:
Dr. Friedman receives grant support from Novartis , St. Jude Medical , Medtronics , Repligen , Astra-Zeneca , Roche , and Takeda . He receives royalties from Springer .
Funding Information:
Dr. Ketter receives research support from the Agency for Healthcare Research and Quality, AstraZeneca Pharmaceuticals LP, Cephalon Inc., Eli Lilly and Company, National Institute of Mental Health, Pfizer Inc., and Sunovion Pharmaceuticals. He receives consultant fees from Allergan, Inc. , Avanir Pharmaceuticals , Bristol-Myers Squibb Company , Cephalon Inc. , Forest Pharmaceuticals , Janssen Pharmaceutica Products, LP, Merck & Co., Inc. , Sunovion Pharmaceuticals , and Teva Pharmaceuticals . He has lecture honoraria from Abbott Laboratories, Inc., AstraZeneca Pharmaceuticals LP, GlaxoSmithKline, and Otsuka Pharmaceuticals and receives publication royalties from American Psychiatric Publishing, Inc. In addition, Dr. Ketter's spouse is an employee of and holds stock in Janssen Pharmaceuticals.
Funding Information:
Dr. Nierenberg is a consultant for Abbott Laboratories, AstraZeneca, Basilea, BrainCells Inc., Brandeis University, Bristol-Myers Squibb, Cephalon, Corcept, Eli Lilly & Co., Forest, Genaissance, GlaxoSmithKline, Innapharma, Janssen Pharmaceutica, Jazz Pharmaceuticals, Lundbeck, Merck, Novartis, PamLabs, PGx Health, Pfizer, Ridge Diagnostics, Roche, Sepracor, Schering-Plough, Shire, Somerset, Sunovion, Takeda, Targacept, and Teva. He is a stakeholder in Appliance Computing, Inc. (MindSite); BrainCells, Inc., InfoMed (potential share of income). He receives research support from AHRQ , Bristol-Myers Squibb , Cederroth , Cyberonics , Elan , Forest Pharmaceuticals , GlaxoSmithKline , Janssen Pharmaceutica , Lichtwer Pharma , Eli Lilly , Mylin (formerly Dey Pharmaceuticals), NARSAD , NIMH , Pamlabs , Pfizer , Shire , Stanley Foundation , and Wyeth-Ayerst . Honoraria include MGH Psychiatry Academy in the past 3 years (Prior to 3 years ago, honoraria from Bristol-Myers Squibb, Cyberonics, Forest Pharmaceuticals, GlaxoSmithKline, Eli Lilly, Shire, Wyeth-Ayerst). Dr. Nierenberg receives other income from legal case reviews for CRICO, MBL Publishing for past services as Editor-in-chief of CNS Spectrums, Slack Inc. for services as Associate Editor of Psychiatric Annals, and Editorial Board, Mind Mood Memory, Belvior Publications. He has copyright joint ownership with MGH for Structured Clinical Interview for MADRS and Clinical Positive Affect Scale and additional honoraria from ADURS, American Society for Clinical Psychopharmacology and Zucker Hillside Hospital and Forest and Janssen, Biomedical Development, Boston Center for the Arts, University of Pisa, University of Wisconsin at Madison, University Texas Southwest at Dallas, Health New England and Harold Grinspoon Charitable Foundation and Eli Lilly and AstraZeneca, Brandeis University, International Society for Bipolar Disorder, 2nd East Asian Bipolar Forum, Mid-Atlantic Permanente Research Institute.
Funding Information:
Dr. Thase has been an advisor/consultant to Alkermes, AstraZeneca, Bristol-Myers Squibb, Eli Lilly, Forest Laboratories, GlaxoSmithKline, Janssen Pharmaceuticals, Lundbeck, MedAvante, Merck, Mylan, Neuronetics, Otsuka, Pamlab, PharmaNeuroboost, Pfizer, Rexahn, Roche, Shire, Sunovion, Supernus, Takeda, and Teva, as well as the US Food and Drug Administration and the National Institute of Mental Health. During the same time frame, Dr. Thase has received honoraria for talks from AstraZeneca, Bristol-Myers Squibb, Eli Lilly, Merck, and Pfizer and has received research grants from Alkermes , AstraZeneca , Eli Lilly , Forest , GlaxoSmithKline , Otsuka , PharmaNeuroboost , and Roche , as well as the National Institute of Mental Health and the Agency for Healthcare Research and Quality .
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
C2 - 23911057
AN - SCOPUS:84884418749
VL - 47
SP - 1686
EP - 1693
JO - Journal of Psychiatric Research
JF - Journal of Psychiatric Research
SN - 0022-3956
IS - 11
ER -