Abstract
My experience is that many outcome tools such as the Health of the Nation Outcome Scale (HoNOS) are both too non-specific and insensitive for day to day clinical use. This is supported by the findings of Parabiaghi et al. [2] and these scales are better suited to evaluating long-term outcomes. Similarly, many clinical rating scales such as the Brief Psychiatric Rating Scale [3] are too time consuming for practical and cost-effective use on a consultation by consultation basis.
However self-report scales such as the Depression, Anxiety and Stress Scale (DASS) [4] are easy to use and give good comparative data on a real time basis. The subscales of the DASS have also been shown to correlate well (Spearman's rho<0.6) with the HoNOS [5]. I have been using the DASS for some 5 years to monitor progress of patients with depression and to both demonstrate real change when people report slow progress and to target particular residual symptoms. Also, as it is completed by all patients at their initial assessment I have some practical clinical norms andamworking on a project to formalize these using a large accumulated data sample.
To complement this I am currently developing a selfreport scale covering psychotic symptoms (PPAQ), as these are not sampled by the DASS, and have had this in preliminary use. One interesting finding is that as well as providing comparative data over time it also encourages patients to discuss symptoms that might otherwise pass unnoticed.
On the issue of consent it is my practice to ask all patients at the initial consultation to sign a consent for the use of non-identified data in research and discuss with them usefulness of ‘the forms’.