Clinician Perspective on DSM-5

Transcription

1 Clinician Perspective on DSM-5 Physician and Non-Physician Attitudes, Perceptions and Concerns About the Release of DSM-5 in May 2013

2 INTRODUCTION Publication of the fifth edition of the Diagnostic and Statistical Manual of Mental (DSM-5) in May 2013 promises to change the practice of modern psychiatry and psychology. Development of the DSM-5 has been met with an array of skepticism and opinions from every corner of the mental health field. There is anticipatory concern about changes in diagnostic criteria for high-profile disorders, such as autism, ADHD, and schizophrenia, along with curiosity about changes in other areas, such as diagnoses of intellectual disability, communication disorders, motor disorders, and more. Ultimately, this manual and the way in which clinicians apply its guidance impacts every patient treated by the mental health community. This is a significant development for every mental health clinician. Due to the critical importance of this issue, the Massachusetts General Hospital Psychiatry Academy and MyCME partnered together to conduct an attitudinal survey of clinicians. Groups of our physician and non-physician colleagues were generous in sharing their perceptions and attitudes about DSM-5, as well as their concerns about changing diagnostic criteria, insights on how they think it affects their clinical practice, and their thoughts on what the biggest challenges are. And then, most important, they shared how they plan to review the new diagnostic changes so they can be put into practice. As clinicians ourselves, we each hope that you find these results interesting and relevant in regards to your own feelings and perceptions about DSM-5. We also invite you to join the conversation about this study and tell us what you think we ve started a discussion on the Massachusetts General Hospital Academy Facebook page at and we re interested in your comments. Tristan L. Gorrindo, MD Director, Postgraduate Education Massachusetts General Hospital Jerrold F. Rosenbaum, MD Chief of Psychiatry Massachusetts General Hospital Ken Kramer, PhD SVP, Medical Director Haymarket Medical Education B

3 SECTION ONE METHODOLOGY These results originate from a survey developed by the Massachusetts General Hospital Psychiatry Academy and sent via in December 2012 and January 2013 to members of MyCME, an online community from Haymarket Medical Education that provides innovative CME/CE-certified educational programs. Two survey invitations were sent to 2, % 91.6% PSYCHIATRY 8.4% FAMILY PRACTICE/ INTERNAL MEDICINE 8.4% BY SPECIALTY physicians, physician assistants and nursing professionals, which resulted in 144 total responses. The overall response rate for this survey is 5.1%. 13.2% 1-5 YEARS BY PROFESSION 11.8% 36.8% 2.8% 48.6% 11.1% 31.9% 18.8% 25.0% 6-10 YEARS YEARS YEARS MORE THAN 30 YEARS YEARS IN PRACTICE 48.6% NURSE PRACTITIONER 36.8% PHYSICIAN 11.8% PHYSICIAN ASSISTANT 2.8% OTHER 1

4 SECTION TWO HIGH LEVELS OF ANTICIPATION ABOUT DSM-5 Perhaps due to the significant controversy and conversation around some of the proposed changes in high-profile therapeutic areas, 42% of clinicians overall indicate they have a high level of anticipation about the release of DSM-5, with an additional 40% who say they are somewhat eager. A significantly higher level of physicians, 11.3%, indicate they are indifferent about the release of DSM-5, when compared with 4.4% for nonphysicians. How do you characterize your level of anticipation about the release of revised DSM-5 diagnostic criteria in May 2013? PHYSICIANS NON-PHYSICIANS Those with high levels of anticipation echo what we hear from our colleagues in the community, which is that frontline clinicians are concerned about how these new criteria impact how they treat patients, as well as patient perceptions about their diagnoses. LEVEL OF ANTICIPATION 35.8% 35.8% VERY EAGER TO SEE THE REVISED GUIDELINES SOMEWHAT EAGER TO SEE WHAT S CHANGED 45.1% 42.9% 11.3% INDIFFERENT 4.4% 15.1% 1.9% WILL PAY ATTENTION WHEN IT IMPACTS MY CLINICAL PRACTICE NOT REALLY INTERESTED AT ALL 6.6% 1.1% Jerrold F. Rosenbaum, MD We do think it s notable that, despite upcoming fundamental changes in diagnostic criteria for major psychiatric conditions, 2 out of 10 clinicians indicate a low level of interest or no interest in the release of DSM-5. This seems to be particularly true for physicians. Individuals that practiced during the release of DSM-IV and DSM-IV-TR may feel less anticipation about the next iteration of DSM. Tristan L. Gorrindo, MD 2

5 SECTION THREE SOME CONCERN ABOUT UNDERSTANDING DIAGNOSTIC CHANGES Perhaps reflecting the ongoing dialogue about the impact of the updates in DSM-5, two-thirds of clinicians say they have some level of concern about understanding these changes. More physicians say they are very concerned (28%), compared with non-physicians (9%). How difficult do you anticipate it will be to understand revisions, updates, or changes in the DSM-5 diagnostic criteria? Recent changes to CPT coding and upcoming changes in DSM-5 and ICD- 10 diagnostic criteria are dramatically changing the way physicians bill and document. How third party payers will adopt these new diagnostic criteria also has implications for physicians seeking prior authorizations and higher levels of care. Successful navigation of the system depends on putting in the time to understand new diagnostic criteria. Tristan L. Gorrindo, MD 16.0% ANTICIPATING DIFFICULTY 33.3% 50.7% 33.3% 50.7% VERY CONCERNED THAT IT WILL BE COMPLICATED SOMEWHAT CONCERNED THAT IT LL TAKE SOME TIME TO UNDERSTAND How difficult do you anticipate it will be to understand revisions, updates, or changes in the DSM-5 diagnostic criteria? PHYSICIANS 28.3% VERY CONCERNED 8.8% 37.7% NON-PHYSICIANS SOMEWHAT DIFFICULT 58.2% BY PROFESSION 16.0% NOT EXPECTING IT TO BE TOO DIFFICULT 34.0% NOT TOO DIFFICULT 33.0% 3

6 SECTION THREE SOME CONCERN ABOUT UNDERSTANDING DIAGNOSTIC CHANGES How confident are you about being able to put revised DSM-5 guidelines into clinical practice? 6.9% 14.6% While 45% of respondents are confident they can translate DSM-5 updates into clinical practice quite easily, another 40% indicate some level of concern that it will take time to understand changes in DSM-5 and incorporate them into practice. A notably higher percentage of physicians says they re very concerned (15%), compared with non-physicians (2%). 33.3% LEVEL OF CONFIDENCE 14.6% 45.1% 33.3% 45.1% VERY CONFIDENT THAT I LL PICK IT UP AND WON T MISS A BEAT SOMEWHAT CONFIDENT THAT I CAN PUT THEM INTO PRACTICE WITHOUT TOO MUCH CONCERN A BIT CONCERNED THAT IT LL TAKE SOME TIME TO UNDERSTAND AND PUT INTO PRACTICE How confident are you about being able to put revised DSM-5 guidelines into clinical practice? PHYSICIANS 15.1% NON-PHYSICIANS VERY CONFIDENT 14.3% 32.1% SOMEWHAT CONFIDENT 52.7% BY PROFESSION 6.9% VERY CONCERNED ABOUT DIGESTING THE REVISIONS AND INCORPORATING THEM INTO CLINICAL PRACTICE 37.7% 15.1% A BIT CONCERNED 30.8% VERY CONCERNED 2.2% 4

7 SECTION FOUR CONCERNS CENTER ON TIME, ACCESS, AND PAYMENT ISSUES Across the board, clinicians say their biggest concern about the release of DSM-5 is the time they believe it s going to take to review, digest, and understand the new diagnostic criteria. Other major concerns include changing actual clinical practice techniques, timely access to education on DSM-5, and insurance, coding, and reimbursement-related issues. A challenge for educational providers is to quickly turn DSM-5 into accessible education for physicians and nonphysicians alike. Ken Kramer, PhD Across all mental health professions, our colleagues concerns about DSM-5 highlight the importance of enhancing understanding and implementation. Aspects of this effort affect everyone in your practice or institution, from physicians to nurses to office staff. Jerrold F. Rosenbaum, MD CLINICIAN CONCERNS ABOUT DSM-5 COMPLEXITY NEW CODES & CODING REQUIREMENTS RELIANCE ON CURRENT DIAGNOSTIC CRITERIA INSURANCE- RELATED ISSUES GOVERNMENT-RELATED ISSUES OVER-RELIANCE ON MEDICATIONS DOCUMENTATION GUIDELINES TIME REQUIRED & AVAILABLE TO UNDERSTAND & LEARN COSTS TIMELY ACCESS TO EDUCATION ON THE NEW GUIDELINES REIMBURSEMENT-RELATED ISSUES CHANGING ACTUAL CLINICAL PRACTICE UPDATES TO EMRS BREADTH OF CHANGES 5

8 SECTION FIVE CONCERNS CROSS VARIOUS THERAPEUTIC AREAS The concerns clinicians have about DSM-5 stretch across a variety of therapeutic areas. Bipolar disorder, autism spectrum disorders, depression, substance use disorders, and PTSD rank as the top five. When asked to identify only one area, more than 21% of clinicians cite bipolar disorder as their primary area of concern, followed by autism spectrum disorders and psychosis. It is noteworthy that six in ten clinicians express concern about diagnostic changes for bipolar disorder, particularly pediatric bipolar disorder. Ken Kramer, PhD As a child psychiatrist, changes to the diagnostic criteria for autism spectrum disorders have a significant impact on my patients, particularly as it relates to disability and educational services. It is rare that an individual psychiatrist is a true generalist; most have some specific practice expertise. The breadth of concern noted in the survey reflects that diversity. Tristan L. Gorrindo, MD Which therapeutic areas are you concerned about in regards to the impact of potential revisions, updates, or changes in the DSM-5 diagnostic criteria? THERAPEUTIC AREAS 60% 40% 20% 0% 20% 35.4% ADHD 47.9% Autism Spectrum Anxiety Bipolar Disorder Depression Eating OCD Psychosis PTSD Substance Abuse Which one therapeutic area are you most concerned about in regards to the impact of potential revisions, updates, or changes in the DSM-5 diagnostic criteria? 19.4% 38.9% 59.0% 21.5% 47.2% 20.8% 25.0% 37.5% 41.0% 45.8% 29.9% Suicide 10% 0% 9.7% ADHD Autism Spectrum 4.2% Anxiety Bipolar Disorder 9.7% Depression 1.4% 0% Eating 12.5% 8.3% 11.1% OCD Psychosis PTSD Substance Abuse 2.1% Suicide 6

9 SECTION SIX MAJORITY EXPECT IMPACT ON CLINICAL PRACTICE More than six in ten clinicians feel the changes to DSM-5 will have at least a somewhat significant impact on their clinical practice, with more than a quarter of physicians expecting a very significant impact 10% more than their non-physician colleagues. In addition, 11% of physicians aren t yet sure what impact DSM-5 will have. How significant an impact do you expect the revised DSM-5 guidelines to have on your clinical practice? 24.5% 11.3% 26.4% PHYSICIANS Nearly three in ten of our colleagues report that DSM-5 won t impact their practice much at all, despite the significant revisions in diagnostic criteria for major psychiatric disorders, and the certain requirements to follow from third-party payers. Jerrold F. Rosenbaum, MD 37.7% 26.4% VERY SIGNIFICANT 37.7% SOMEWHAT SIGNIFICANT 24.5% NOT MUCH IMPACT AT ALL 11.3% NOT SURE 6.6% 16.5% BY PROFESSION When we ve seen significant interest in any issues or trends, or significant changes to treatment guidelines, we ve also seen parallel high demand in education on those topics. Ken Kramer, PhD 28.6% NON-PHYSICIANS 48.4% 16.5% VERY SIGNIFICANT 48.4% SOMEWHAT SIGNIFICANT 28.6% NOT MUCH IMPACT AT ALL 6.6% NOT SURE 7

10 SECTION SEVEN HIGH INTEREST IN EDUCATION ON DSM-5 In a sentiment that seems to echo the high level of dialogue concerning DSM-5, the vast majority of mental health clinicians plan to get up-tospeed quickly with the manual s new guidelines. Nearly half (47%) of all clinicians say they plan to look for information on DSM-5 as soon as it s released, and another 30% plan to look for Since the majority of clinicians plan to look for information about DSM-5 quickly, it s important for larger health systems to help disseminate the manual and appropriate guidance to their staffs and into their communities. information a short time later. Tristan L. Gorrindo, MD Online education is poised to be the preferred format (49%) for information about DSM-5, while nearly a quarter of clinicians will turn to journals. TIMING FOR EDUCATION ON DSM-5 When do you plan to obtain education on the revised DSM-5 diagnostic criteria? 47.2% 30.6% 16.7% 5.6% THE MINUTE IT S RELEASED I LL LOOK AT IT A SHORT TIME AFTER IT S RELEASED I LL GO LOOK FOR SOME INFO NOT SURE, I LL CATCH UP ON IT WHEN I HAVE TIME WILL PAY ATTENTION WHEN IT IMPACTS MY CLINICAL PRACTICE How do you plan to obtain education about the revised DSM-5 diagnostic criteria after it s released? 6.3% 14.6% 49.3% 24.3% 5.6% ATTENDING THE 2013 APA ANNUAL CONFERENCE ATTENDING OTHER 2013 CONFERENCES SPECIFICALLY ABOUT DSM-5 PARTICIPATING IN ONLINE EDUCATION SPECIFICALLY ABOUT DSM-5 READING JOURNALS AND OTHER PRINTED MATERIALS ATTENDING LOCAL GRAND ROUNDS AT MY EMPLOYER OR ANOTHER FACILITY FORMATS FOR EDUCATION ON DSM-5 The accessibility and lower cost of online education makes perfect sense for this type of broad, interdisciplinary change in guidelines so online education providers should be proactive in developing highquality education on DSM-5. Ken Kramer, PhD 8

11 ABOUT THE MASSACHUSETTS GENERAL HOSPITAL PSYCHIATRY ACADEMY For physicians and healthcare professionals who value the highest standards of clinical care, the Massachusetts General Hospital (MGH) Psychiatry Academy is dedicated to providing world-renowned postgraduate education that improves clinical practice and leads to better lives for patients and their families. Advanced teaching methods, an interactive learning format, and a focus on solving real-world, practice-related challenges give the MGH Psychiatry Academy international recognition for helping providers effectively diagnose and treat a compendium of diseases and illnesses. MGH Psychiatry Academy membership includes more than 35,000 healthcare professionals in more than 120 countries around the world and 10,000 patients, family members, and caregivers. Through its expertise in the evolution of healthcare education and online learning, the MGH Psychiatry Academy disseminates more than 100,000 learning activities per year through web-based, interactive learning modules and clinical simulations; oneday live symposia in cities across the country; online Maintenance of Certification (MOC) modules; tuition-based, four-week, interactive online courses; interactive e-books accessible via smartphones and tablets; online board review courses; and multi-day, in-depth conferences. To learn more, visit today. ABOUT MYCME mycme, a division of Haymarket Medical Education, provides clinically relevant, independent, certified medical education online to physicians, nurse practitioners, physician assistants, and other healthcare professionals based in the U.S. and around the globe. Launched in 2009, mycme has quickly grown into a premier online educational site that provides impactful, practice-changing CME and CE across multiple specialties with an average of 275 educational activities available at any time. In the past 4 years, the site has seen significant growth, resulting in more than 300,000 certificates used in 2012 alone. mycme is a part of a network of digital and print properties produced and developed by Haymarket. The network reaches more than 495,000 clinicians in the U.S., with the ability for them to access mycme through any computer as well as their smartphones and tablets through the mycme App. 9