Precision Guided Behavioral Care is a fully automated, personalized medicine tool that combines traditional outcomes with patient-specific daily monitoring of symptoms and goals. The tool is available on smart phones and mobile devices.
Precision Guided Behavioral Care is not a digital therapist or an app designed to replace the therapist. It is predicated on the centrality of the therapist/patient relationship. This new tool extends the therapeutic process by providing the clinician with a greater understanding of the patient’s circumstances outside the therapy session; and promotes better communication and active collaboration on shared goals. The end result, we hope, will be greater patient satisfaction and better outcomes, achieved more quickly.
Psychotherapy research indicates outcomes tracking improves care when clinicians are alerted that a patient is deteriorating or not making adequate progress, but this applies to only about 8% of patients. Outcomes feedback has not shown benefit to the other 92% of patients.* We think this is because standard outcomes measures do not provide fine-grained clinically actionable information.
Personalized progress tracking uses what’s called ecological momentary assessment/intervention to sample data in real time, either daily or throughout the day (our initial version will sample data once a day).** This expands the range of data available to the clinicians giving them a better handle on how treatment is affecting the patients’ most salient symptoms and how they are progressing toward their goals when they are not being seen in therapy.
Here’s how it works. In addition to responding at regular intervals (weekly/monthly) to a standard outcome measure such as the PHQ-9 or GAD-7, the patient will respond daily to a small set of patient-specific questions. Clinicians select questions from a library (they can also create their own) and review the results before or during the treatment session. The library of questions is organized into categories: depression, anxiety, relationships, functioning, medication adherence, etc.
Initially, there will be up to 4 questions answered with a slider bar and a textbox. Patients can respond in a matter of seconds. All measures are “pushed” to the patient’s smartphone at the end of the day and the patient is reminded to take a followup.
Research has shown that awareness and behavior are altered when a person is observed, or even with self-monitoring. By drawing the patient’s attention to problematic cognitions/behaviors, outside the therapy hour, we expect the patient to gain a better understanding of themselves and their symptoms; at the same time the therapist is given access to information that can provide a deeper appreciation of the patient’s functioning outside the consulting room.
The app for android is available in the Google Play store. An IOS app (for Iphones) is available in the Apple store. Initially, the system will focus on adult issues, but we will add child and adolescent measures and symptom/goals in the near future. We will be doing ongoing evaluation of the system on outcomes, patient engagement, and persistence in treatment.
* Feedback to prescribers of psychiatric medication, has shown to have a much more broad based impact on outcomes than feedback to psychotherapists.
**See this link for a meta-analysis of ecological momentary inventions in mental health:http://www.jmir.org/2016/6/e152/