Barriers to and facilitators of measurement-based care in posttraumatic stress disorder treatment: A systematic review

Abstract: Introduction: Measurement-based care (MBC) involves routine monitoring of patient-reported outcomes to inform clinical decision-making. Despite evidence demonstrating its effectiveness in the treatment of patients with posttraumatic stress disorder (PTSD) and other psychiatric conditions, it remains underutilized in clinical settings. This review aimed to identify the barriers to and facilitators of the use of MBC in patients with PTSD. Methods: We conducted a systematic review following the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines, including articles that examined barriers to and facilitators of the use of MBC in patients with PTSD. Facilitators and barriers were defined as any factors that impacted the implementation, uptake, or use of MBC. The search was conducted in December 2024 in four databases. Results: Our search identified 6,036 unique articles, of which 15 met the inclusion criteria. All 15 articles were published in the United States, and 11 studied Veteran populations. Barriers to and facilitators of MBC in PTSD varied widely between studies; commonly identified barriers included irregular completion of outcome measures, technological challenges, and poor patient understanding of MBC purpose and results. Facilitators included technological accessibility to patients and clinicians, patient consultation on the selection of outcome measures, and use of frameworks to guide implementation. Discussion: This review identified a limited number of studies examining barriers to and facilitators of MBC use and implementation for PTSD, highlighting gaps in the literature. Implementation studies are needed to explore context-specific barriers and facilitators, providing a more comprehensive understanding of MBC in PTSD care. Lay Summary: Measurement-based care (MBC) involves regularly monitoring patient outcomes through standardized assessment tools to guide treatment decisions. Although research suggests that MBC is a valuable tool in the treatment of posttraumatic stress disorder (PTSD), health care providers and patients have not fully adopted this approach. To understand the lack of adoption, we reviewed the literature to identify barriers and facilitators to MBC in patients with PTSD. Our research identified several barriers to MBC, including low completion of assessments, technological difficulties, and poor explanation of the purpose of MBC to patients. Facilitators of MBC included user-friendly technology and collaboration between health care providers and patients to identify patient goals. While MBC has been utilized in PTSD treatment for Veteran and military populations, there is a lack of research on its implementation. By leveraging established implementation frameworks and increasing the amount of research on MBC for PTSD, MBC can be refined to ensure it enhances patient care while minimizing burden on both patients and providers.