Patients’ and Psychologists’ Preferences for Feedback Reports on Expected Mental Health Treatment Outcomes: A Discrete-Choice Experiment

In recent years, there has been an increasing focus on routine outcome monitoring (ROM) to provide feedback on patient progress during mental health treatment, with some systems also predicting the expected treatment outcome. The aim of this study was to elicit patients’ and psychologists’ preferences regarding how ROM system-generated feedback reports should display predicted treatment outcomes. In a discrete-choice experiment, participants were asked 12–13 times to choose between two ways of displaying an expected treatment outcome. The choices varied in four different attributes: representation, outcome, predictors, and advice. A conditional logistic regression was used to estimate participants’ preferences. A total of 104 participants (68 patients and 36 psychologists) completed the questionnaire. Participants preferred feedback reports on expected treatment outcome that included: (a) both text and images, (b) a continuous outcome or an outcome that is expressed in terms of a probability, (c) specific predictors, and (d) specific advice. For both patients and psychologists, specific predictors appeared to be most important, specific advice was second most important, a continuous outcome or a probability was third most important, and feedback that includes both text and images was fourth in importance. The ranking in importance of both the attributes and the attribute levels was identical for patients and psychologists. This suggests that, as long as the report is understandable to the patient, psychologists and patients can use the same ROM feedback report, eliminating the need for ROM administrators to develop different versions.

     

Predicting Future Service Use in Dutch Mental Healthcare: A Machine Learning Approach

A mental healthcare system in which the scarce resources are equitably and efficiently allocated, benefits from a predictive model about expected service use. The skewness in service use is a challenge for such models. In this study, we applied a machine learning approach to forecast expected service use, as a starting point for agreements between financiers and suppliers of mental healthcare. This study used administrative data from a large mental healthcare organization in the Netherlands. A training set was selected using records from 2017 (N?=?10,911), and a test set was selected using records from 2018 (N?=?10,201). A baseline model and three random forest models were created from different types of input data to predict (the remainder of) numeric individual treatment hours. A visual analysis was performed on the individual predictions. Patients consumed 62 h of mental healthcare on average in 2018. The model that best predicted service use had a mean error of 21 min at the insurance group level and an average absolute error of 28 h at the patient level. There was a systematic under prediction of service use for high service use patients. The application of machine learning techniques on mental healthcare data is useful for predicting expected service on group level. The results indicate that these models could support financiers and suppliers of healthcare in the planning and allocation of resources. Nevertheless, uncertainty in the prediction of high-cost patients remains a challenge.

     

Rapid on-line profiling of estrogen receptor binding metabolites of tamoxifen

Here we present a high-resolution screening (HRS) methodology for postcolumn on-line profiling of metabolites with affinity for the estrogen receptor alpha (ERalpha). Tamoxifen, which is metabolized into multiple metabolites, was used as the model compound. Most of the 14 metabolites detected exhibited affinity for the ERalpha. The HRS methodology shows great potential for metabolite bio-affinity profiling and application in drug discovery and development.     

Modeling the cost-effectiveness of health care systems for alcohol use disorders: how implementation of eHealth interventions improves cost-effectiveness

Background

Informing policy decisions about the cost-effectiveness of health care systems (ie, packages of clinical interventions) is probably best done using a modeling approach. To this end, an alcohol model (ALCMOD) was developed.

Objective

The aim of ALCMOD is to estimate the cost-effectiveness of competing health care systems in curbing alcohol use at the national level. This is illustrated for scenarios where new eHealth technologies for alcohol use disorders are introduced in the Dutch health care system.

Method

ALCMOD assesses short-term (12-month) incremental cost-effectiveness in terms of reductions in disease burden, that is, disability adjusted life years (DALYs) and health care budget impacts.

Results

Introduction of new eHealth technologies would substantially increase the cost-effectiveness of the Dutch health care system for alcohol use disorders: every euro spent under the current system returns a value of about the same size (€ 1.08, ie, a “surplus” of 8 euro cents) while the new health care system offers much better returns on investment, that is, every euro spent generates € 1.62 in health-related value.

Conclusion

Based on the best available evidence, ALCMOD''s computations suggest that implementation of new eHealth technologies would make the Dutch health care system more cost-effective. This type of information may help (1) to identify opportunities for system innovation, (2) to set agendas for further research, and (3) to inform policy decisions about resource allocation.     

Exploring Parenting Profiles to Understand Who Benefits from the Incredible Years Parenting Program

Prevention Science - Behavioral parenting programs are a theory-driven and evidence-based approach for reducing disruptive child behavior. Although these programs are effective on average, they are...     

A Cost-Effectiveness Analysis to Evaluate a System Change in Mental Healthcare in the Netherlands for Patients with Depression or Anxiety

Over the last decade, the Dutch mental healthcare system has been subject to profound policy reforms, in order to achieve affordable, accessible, and high quality care. One of the adjustments was to substitute part of the specialized care for general mental healthcare. Using a quasi-experimental design, we compared the cost-effectiveness of patients in the new setting with comparable patients from specialized mental healthcare in the old setting. Results showed that for this group of patients the average cost of treatment was significantly reduced by, on average, €2132 (p?<?0.001), with similar health outcomes as in the old system.     

Proton Pump Inhibitors Reduce Duodenal Eosinophilia,Mast Cells,and Permeability in Patients With Functional Dyspepsia

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The impact of short-term ciclosporin A treatment on insulin secretion and insulin sensitivity in man

Background. The objectives of the present study were to investigatethe possible adverse effects of ciclosporin A (CsA, SandimmunNeoral®) on insulin secretion and insulin sensitivity (IS)in man. Methods. A total of 11 Caucasian non-diabetic haemodialysis(HD) patients were recruited from the Norwegian transplant waitinglist to participate in this study. The patients underwent twoconsecutive 3 h hyperglycaemic glucose clamp procedures, beforeand following 2 weeks of oral CsA treatment. Statistical analysesincluded nine patients (7M/2F, mean age 61 ± 14 years)as two patients were withdrawn due to side effects and poorcompliance. First and second phase insulin secretion (Secr_1.phaseand Secr_2.phase) were estimated as area under the insulin serumconcentration vs time curve (AUC) during the first 10 min andthe last hour of the clamp, respectively. The IS index (ISI)was calculated as the glucose disposal rate corrected for insulinlevels during the last 60 min of the procedure. Results. Secr_2.phase decreased significantly (30%) followingCsA treatment (P = 0.045). In contrast, no significant changewas observed in the average Secr_1.phase or ISI, although relativelylarge inter-individual differences were present. Calculationbased on C-peptide concentrations gave the same results. Nosignificant changes in body weight, dialysis status, patientmedication or safety parameters were observed. Conclusions. Short-term treatment with CsA at doses used followingtransplantation seems to impair Secr_2.phase, but has no significanteffect on Secr_1.phase, in Caucasian HD patients. The mechanismbehind these findings and their possible clinical implicationsneed further study.