JMIR Publications

ABSTRACT

Background:

Although measurement-based care (MBC), including remote MBC, is increasingly being considered or implemented for mental health treatment and outcomes in routine clinical care, little is known about the health equity implications in real-world practice as well as the impact on patient-provider relationships in lower-resource systems which offer mental health treatment for diverse patients.

Objective:

This hypothesis-generating study of measurement-based care (MBC) in a safety net mental health setting focuses on drivers of implementation outcomes, health equity implications, and the impact of MBC on Therapeutic Alliance (TA). The study took place one year after the implementation of remote MBC at three outpatient adult clinics in a diverse, safety net health system.

Methods:

This explanatory sequential mixed methods study used quantitative surveys and qualitative focus groups with mental health providers. Repeated surveys were first used to understand mental health provider experiences over a six-month period, at least one year after MBC implementation. Surveys were analyzed to refine focus group prompts. Seven mental health providers participated in repeated surveys over 6 months, followed by focus groups.

Results:

Surveys revealed stable Acceptability and Utility ratings, concerns MBC was not equally benefiting patients, little endorsement that MBC improved TA, and slightly decreasing Feasibility scores. In focus groups, providers shared concerns about the Acceptability, Appropriateness, Feasibility, and Equity of processes for Collecting MBC data. Providers had less first-hand experience but some further concerns around processes for Sharing and Acting upon the data. TA both impacted and was impacted by MBC in positive and negative ways. Potential drivers of the findings are discussed using qualitative data.

Conclusions:

More than one year after implementation of remote MBC for mental health, providers had enduring concerns about health equity implications of the practice as well as reported bidirectional relationship between MBC and TA with patients. Based on these findings, further rigorous study is needed to identify system-level strategies to mitigate any potential negative health equity impacts of real-world MBC implementations, particularly in low-resource settings with diverse populations.