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Implementation of outcome measurement (HoNOS) in an outpatient psychiatric clinic in Sligo/Leitrim mental health service

Irish Journal of Medical Science (1971 -) volume 188, pages 1329–1335 (2019)Cite this article

Abstract

Background

Routine clinical outcome monitoring (RCOM) is the standardised gathering of measures of clinical outcomes in everyday practice. HoNOS (Health of the Nation Outcome Scales) is a tool used in RCOM.

Aims

To examine (a) agreement between HoNOS and Global Assessment of Functioning (GAF), (b) HoNOS changes over time/attendance and (c) clinical parameters affecting HoNOS scores.

Methods

Data from outpatient clinics were collected at each contact over 2 years until June 2016 including: gender, age, diagnosis (ICD-10) and HoNOS scores. In a subsample, the GAF also were completed by community psychiatric nurses blind to HoNOS scores.

Results

A number of 470 outpatients have undergone 1125 HoNOS assessments during the study period. Mean age of the attendants was 43.12; SD 14.6. Male = 220 (46.8%). Longitudinal analysis demonstrated that lower HoNOS scores are independently significantly associated to number of assessments and diagnosis in ICD-10 categories of F20–F29 (Schizophrenia, schizotypal and delusional disorders) F30–F39 (mood disorders) F40–F48 (neurotic, stress-related and somatoform disorders) and F50–F59 (behavioural disorders associated with physiological disturbances). Gender and age were not significantly associated with decline of HoNOS scores. Neither were other diagnostic categories. Agreement between HoNOS and GAF was excellent (N = 261, rho = − 0.919, p < 0.001).

Conclusions

This study shows that HoNOS is a feasible instrument which can be potentially used in ROCM in mental health services in Ireland and supports further the need for implementation of routine measurements in Mental Health Services. It adds longitudinal data which is lacking in similar previous studies.

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References

  1. Carlier IVE, Meuldijk D, van Vliet IM, van Fenema E, van der Wee NJA, Zitman FG (2012) Routine outcome monitoring and feedback on physical or mental health status: evidence and theory. J Eval Clin Pract 18(1):104–110

    Article  Google Scholar 

  2. Quality and Effectiveness Section Mental Health & Suicide Prevention Branch Department of Health and Ageing (2003) Mental health national outcomes and case mix collection: overview of clinician related and consumer self-report measures

    Google Scholar 

  3. New Zealand Ministry of Health (2012), Rising to the challenge: the Mental Health and Addiction Service Development Plan 2012–2017

  4. Mental Health Commission Ireland (2006) Mental Health Commission Ireland Quality Framework for Mental Health Services

  5. Wing JK, Beevor AS, Curtis RH, Park SGB, Hadden J, Burns A (1998) Health of the Nation Outcome Scales (HoNOS). Research and development. Br J Psychiatry 172:11–18

    Article  CAS  Google Scholar 

  6. McCrossan P, Ryan A, Connellan M, Power P (2017) The impact of a specialized inpatient and day patient group programme on clinical outcome in older adolescents and young adults with mental illness. Ir J Psychol Med 34(1):39–44

    Article  CAS  Google Scholar 

  7. O’Brien S, McFarland J, Kealy B, Pullela A, Saunders J, Cullen W, Meagher D (2012) A randomized-controlled trial of intensive case management emphasizing the recovery model among patients with severe and enduring mental illness. Ir J Med Sci 181(3):301–308

    Article  Google Scholar 

  8. Pirkis JE, Burgess PM, Kirk PK et al (2005) A review of the psychometric properties of the Health of the Nation Outcome Scales (HoNOS) family of measures. Health Qual Life Outcomes 3(2005):76

    Article  Google Scholar 

  9. American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders: DSM-IV. American Psychiatric Association

  10. Hall RC (1995) Global assessment of functioning. A modified scale. Psychosomatics 36(3):267–275

    Article  CAS  Google Scholar 

  11. Microsoft Corporation. SQL Server (2008) R2. Redmond. Microsoft Corporation, Washington, p 2010

    Google Scholar 

  12. IBM Corp (2014) IBM SPSS statistics for Windows. In: Version 23, vol 0. NY, Armonk

    Google Scholar 

  13. Browne S, Doran M, McGauran S (2000) Health of the Nation Outcome Scales (HoNOS): use in an Irish psychiatric outpatient population. Ir J Psychol Med 17(1):17–19

    Article  Google Scholar 

  14. Meagher D, O’Brien S, Pullela et al (2009) Multidisciplinary activities in a community mental health service: relationship to Health of the Nation Outcome Scale scores and diagnosis. Psychiatrist 33(5):172–175

    Google Scholar 

  15. Trauer T, Coombs T, Eagar K (2002) Training in routine mental health outcome assessment: the Victorian experience. Aust Health Rev 25(2):122–128

    Article  Google Scholar 

  16. Amin S, Singh SP, Croudace T, Jones P, Medley I, Harrison G (1999) Evaluating the Health of the Nation Outcome Scales. Reliability and validity in a three-year follow-up of first-onset psychosis. Br J Psychiatry 174(5):399–403

    Article  CAS  Google Scholar 

  17. Parker G, O'Donnell M, Hadzi-Pavlovic D, Proberts M (2002) Assessing outcome in community mental health patients: a comparative analysis of measures. Int J Soc Psychiatry 48(1):11–19

    Article  Google Scholar 

  18. Phuaphanprasert B, Srisurapanont M, SilpakitMD C et al (2007) Reliability and validity of the Thai version of the Health of the Nation Outcome Scales (HoNOS). J Med Assoc Thail 90(11):2487–2493

    Google Scholar 

  19. Killaspy H, Banerjee S, King M et al (2000) Prospective controlled study of psychiatric out-patient non-attendance: characteristics and outcome. Br J Psychiatry (2000) 176:160–165

    Article  CAS  Google Scholar 

  20. Eagar K, Trauer T, Mellsop G (2005) Performance of routine outcome measures in adult mental health care. Aust N Z J Psychiatry 39(8):713–718

    Article  Google Scholar 

  21. Trauer T (2003) Analysis of outcome measurement data from the four Victorian round one agencies. In: Mental health branch. Department of Human Services, Victoria

    Google Scholar 

  22. Trauer T, Callaly T, Little J et al (1999) Health of the Nation Outcome Scales (HoNOS): results of the Victorian field trial. Br J Psychiatry 174:380–388

    Article  CAS  Google Scholar 

  23. Macdonald AJ, Adamis D, Craig, et al. (2018) Continuity of care and clinical outcomes in thecommunity for people with severe mental illness. The British Journal of Psychiatry(2018): 1-6. Published online: 05 December 2018

  24. Trauer T, Gill L, Pedwell G, Slattery P (2006) Routine outcome measurement in public mental health—what do clinicians think? Aust Health Rev 30(2):144–147

    Article  Google Scholar 

  25. Coombs T, Stapley K, Pirkis J (2011) The multiple uses of routine mental health outcome measures in Australia and New Zealand: experiences from the field. Australas Psychiatry 19(3):247–253

    Article  Google Scholar 

  26. Happell B (2008) Meaningful information or a bureaucratic exercise? Exploring the value of routine outcome measurement in mental health. Issues Ment Health Nurs 29(10):1098–1114

    Article  Google Scholar 

  27. Meehan T, McCombes S, Hatzipetrou L et al (2006) Introduction of routine outcome measures: staff reactions and issues for consideration. J Psychiatr Ment Health Nurs 13(5):581–587

    Article  CAS  Google Scholar 

  28. Walter G, Cleary M, Rey JM (1998) Attitudes of mental health personnel towards rating outcome. J Qual Clin Pract 18(2):109–115

    CAS  PubMed  Google Scholar 

  29. Macdonald AJ, Trauer T (2010) Objections to routine clinical outcomes measurement in mental health services: any evidence so far? J Ment Health 19(6):517–522

    Article  Google Scholar 

  30. Callaly T, Hyland M, Coombs T, Trauer T (2006) Routine outcome measurement in public mental health: results of a clinician survey. Aust Health Rev 30(2):164–173

    Article  Google Scholar 

  31. Trauer T, Pedwell G, Gill L (2009) The effect of guidance in the use of routine outcome measures in clinical meetings. Aust Health Rev 33(1):144–151

    Article  Google Scholar 

  32. Willis A, Deane FP, Coombs T (2009) Improving clinicians' attitudes toward providing feedback on routine outcome assessments. Int J Ment Health Nurs 18(3):211–215

    Article  Google Scholar 

  33. Boswell JF, Kraus DR, Miller SD, Lambert MJ (2015) Implementing routine outcome monitoring in clinical practice: benefits, challenges, and solutions. Psychother Res 25(1):6–19

    Article  Google Scholar 

  34. Macdonald AJ, Fugard AJ (2015) Routine mental health outcome measurement in the UK. Internat Rev Psychiatry 27(4):306–319

    Article  Google Scholar 

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Acknowledgments

We would like to thank the Doctors and CPNs working in this Mental Health Team for completion of the scales.

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Authors and Affiliations

  1. Sligo Leitrim Mental Health Service, Clarion Road, Sligo, Co. Sligo, Ireland

    James Sweeney, Dimitrios Adamis & Luqman Helmi

  2. Clinical Outcomes Research, Institute of Psychiatry, Psychology and Neuroscience, London, UK

    Alastair J. D. Macdonald

Authors
  1. James Sweeney
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  2. Dimitrios Adamis
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  3. Luqman Helmi
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  4. Alastair J. D. Macdonald
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Corresponding author

Correspondence to James Sweeney.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

This article does not contain any studies with human participants performed by any of the authors.

The project was approved by the Ethics Committee of Sligo University Hospital.

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Sweeney, J., Adamis, D., Helmi, L. et al. Implementation of outcome measurement (HoNOS) in an outpatient psychiatric clinic in Sligo/Leitrim mental health service. Ir J Med Sci 188, 1329–1335 (2019). https://doi.org/10.1007/s11845-019-02015-6

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  • DOI: https://doi.org/10.1007/s11845-019-02015-6

Keywords

  • HoNOS
  • Ireland
  • Outcomes
  • Outpatient
  • Psychiatry