Intended for healthcare professionals

Practice Uncertainties

Do PROMS improve outcomes in patients with depression in primary care?

BMJ 2020; 370 doi: https://doi.org/10.1136/bmj.m3313 (Published 08 September 2020) Cite this as: BMJ 2020;370:m3313
  1. Tony Kendrick, professor of primary care,
  2. Emma Maund, research fellow
  1. Primary Care and Population Sciences, University of Southampton, Southampton, UK
  1. Correspondence to: Tony Kendrick A.R.Kendrick{at}soton.ac.uk

What you need to know

  • Patient reported outcome measures (PROMS) are questionnaires used in the initial assessment of patients with depression and for monitoring progress with treatment

  • There is insufficient evidence, and mostly of low quality, that routine monitoring with PROMS in primary care leads to improvement in outcomes in terms of symptoms of depression

  • Routine use of PROMs in primary care for depression is not established, but they may be beneficial in certain patients who are not able to articulate their symptoms or are unsure if they have depression, and can help patients feel more involved in their care

Patient reported outcome measures (PROMs) are questionnaires or brief interviews assessing patients’ symptoms, social functioning, and health related quality of life.1 PROMs provide feedback on patients’ responses to treatment, so healthcare practitioners may then adjust treatment or refer for alternative interventions.1 Their use in the assessment of severity of depression and monitoring is widely promoted in primary care, psychological therapy, and mental healthcare settings in the UK, US, and Europe (box 1). In the NHS England Improving Access to Psychological Therapies (IAPT) programme, PROMs for depression, anxiety, and social functioning are routinely administered at every treatment session.2

Box 1

Organisations recommending the use of PROMs for monitoring outcomes in the treatment of depression

  • UK National Institute for Health and Care Excellence (NICE). https://www.nice.org.uk/guidance/qs8/chapter/Quality-statement-1-Assessment

  • NHS England Increasing Access to Psychological Therapies (IAPT) programme. https://www.england.nhs.uk/wp-content/uploads/2020/05/iapt-manual-v4.pdf

  • US Federal Health Resources and Services Administration. https://bphc.hrsa.gov/qualityimprovement/clinicalquality/behavioralhealth/index.html

  • US Department of Veterans Affairs / Department of Defense. https://www.healthquality.va.gov/guidelines/MH/mdd/

  • American Psychiatric Association. https://psychiatryonline.org/pb/assets/raw/sitewide/practice_guidelines/guidelines/mdd.pdf

  • American Psychological Association. https://www.apa.org/depression-guideline/assessment/

  • Kaiser Permanente Health Maintenance Organisation. https://wa-provider.kaiserpermanente.org/static/pdf/provider/patient-ed/screenings/bhi-monitoring-tool.pdf

  • Nederlands Huisartsen Genootschap (Dutch Society of General Practitioners). https://richtlijnen.nhg.org/standaarden/depressie#volledige-tekst-3-beoordelen-van-de-ernst-van-de-depressieve-stoornis

RETURN TO TEXT

PROMs are relatively quick surrogate measures for longer, interview-based assessments of symptoms and functioning. PROMs provide standardised results, readily understandable to other practitioners, and to patients themselves after brief explanations of their meaning. Similar measures can be used to screen for depression and aid …

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