title: The Medication Recommendation Tracking Form: a novel tool for tracking changes in prescribed medication, clinical decision making, and use in comparative effectiveness research.
abstract: This paper describes the development and use of the Medication Recommendation Tracking Form (MRTF), a novel method for capturing physician prescribing behavior and clinical decision making. The Bipolar Trials Network developed and implemented the MRTF in a comparative effectiveness study for bipolar disorder (LiTMUS). The MRTF was used to assess the frequency, types, and reasons for medication adjustments. Changes in treatment were operationalized by the metric Necessary Clinical Adjustments (NCA), defined as medication adjustments to reduce symptoms, optimize treatment response and functioning, or to address intolerable side effects. Randomized treatment groups did not differ in rates of NCAs, however, responders had significantly fewer NCAs than non-responders. Patients who had more NCAs during their previous visit had significantly lower odds of responding at the current visit. For each one-unit increase in previous CGI-BP depression score and CGI-BP overall severity score, patients had an increased NCA rate of 13% and 15%, respectively at the present visit. Ten-unit increases in previous Montgomery Asberg Depression Rating Scale (MADRS) and Young Mania Rating Scale (YMRS) scores resulted in an 18% and 14% increase in rates of NCAs, respectively. Patients with fewer NCAs had increased quality of life and decreased functional impairment. The MRTF standardizes the reporting and rationale for medication adjustments and provides an innovative metric for clinical effectiveness. As the first tool in psychiatry to track the types and reasons for medication changes, it has important implications for training new clinicians and examining clinical decision making. (ClinicalTrials.gov number NCT00667745).
authors.affiliation: Department of Psychiatry, Massachusetts General Hospital, 50 Staniford Street, Suite 580, Boston, MA 02114, USA; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA. Electronic address: nhreilly@partners.org.
authors.forename: Noreen A
authors.initials: NA
authors.lastname: Reilly-Harrington
authors.forename: Louisa G
authors.initials: LG
authors.lastname: Sylvia
authors.forename: Andrew C
authors.initials: AC
authors.lastname: Leon
authors.forename: Leah W
authors.initials: LW
authors.lastname: Shesler
authors.forename: Terence A
authors.initials: TA
authors.lastname: Ketter
authors.forename: Charles L
authors.initials: CL
authors.lastname: Bowden
authors.forename: Joseph R
authors.initials: JR
authors.lastname: Calabrese
authors.forename: Edward S
authors.initials: ES
authors.lastname: Friedman
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Ostacher
authors.forename: Dan V
authors.initials: DV
authors.lastname: Iosifescu
authors.forename: Dustin J
authors.initials: DJ
authors.lastname: Rabideau
authors.forename: Michael E
authors.initials: ME
authors.lastname: Thase
authors.forename: Andrew A
authors.initials: AA
authors.lastname: Nierenberg
mesh_terms: D000293:Adolescent; D000328:Adult; D018692:Antimanic Agents / Q000627:therapeutic use*; D001714:Bipolar Disorder / Q000188:drug therapy*; D057186:Comparative Effectiveness Research; D003657:Decision Making; D005260:Female; D006801:Humans; D018021:Lithium Chloride / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D010355:Patient Identification Systems / Q000379:methods*; D055553:Prescription Drugs / Q000627:therapeutic use; D011569:Psychiatric Status Rating Scales; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D018692:Antimanic Agents; D055553:Prescription Drugs; D018021:Lithium Chloride
keywords: Bipolar disorder; Comparative effectiveness research; Medication algorithms; Medication tracking