March 20, 2009

Federally Funded Treatment Effectiveness Research Should Include Behavioral and Psychosocial Interventions, Says APA President

WASHINGTON -- Because behavior plays a key role in many health conditions, federally funded research that compares the effectiveness of one treatment type with another for the same condition – “comparative effectiveness research” -- should include behavioral and psychosocial interventions, as well as medical interventions, the president of the American Psychological Association testified today.

“We encourage research that compares different behavioral and psychosocial interventions for the prevention and treatment of specific health conditions,” APA President James H. Bray, PhD, testified at a public meeting at the Institute of Medicine. “This research is crucial given that the leading causes of chronic health problems and mortality in the United States – such as heart disease, diabetes and many forms of cancer -- are due to modifiable behavioral factors, such as smoking, improper diet, lack of physical activity and excessive alcohol consumption, among others.”

Comparative effectiveness research compares clinical outcomes of different treatments for the same condition. More evidence on what works and does not work can lead to better health care decisions and thus to improved quality of care, improved efficiency, and ultimately to cost savings throughout the health system, according to APA.

“Comparative effectiveness research is a critically important tool for advancing an evidence-based approach to health care decision-making,” Bray said. “However, the full public health benefits of such research will only be realized if behavioral, psychosocial and medical interventions for the prevention and treatment of mental and physical conditions are evaluated individually and in combination.”

Bray, an associate professor of family and community medicine and psychiatry at the Baylor College of Medicine in Houston, Texas, spoke to the IOM’s Committee on Comparative Effectiveness Research Priorities. IOM has been asked by Congress, in the American Recovery and Reinvestment Act of 2009, to recommend spending priorities on comparative effectiveness research to the secretary of health and human services.

Bray called for research that compares behavioral, medical and combined behavioral/medical interventions to discover the most effective treatments for serious health conditions. He also recommended that the economic stimulus funds allocated to support comparative effectiveness research be used to pursue research that compares integrated, team-based systems of care to more routine-style care.

Additionally, he said, “all health research studies should include measures of behavioral and psychosocial outcomes such as life quality, adherence to treatment protocols, behavioral functioning, depression and anxiety. Such attention to patient-centered care builds upon the IOM’s own definition of evidence-based practice.”

Finally, Bray stressed that research that examines interventions across the lifespan and in different minority and gender groups is needed to better understand the variability of outcomes within and between population groups.

“This type of comparative research is important given the well-documented health disparities that exist between different racial/ethnic, age, socioeconomic status, gender and sexual minority groups, and because it is not clear if specific behavioral and medical interventions are equally effective across groups,” he said. “This type of comparative research is critical as the U.S. population becomes more diverse.”

The American Psychological Association, in Washington, D.C., is the largest scientific and professional organization representing psychology in the United States and is the world's largest association of psychologists. APA's membership includes more than 150,000 researchers, educators, clinicians, consultants and students. Through its divisions in 54 subfields of psychology and affiliations with 60 state, territorial and Canadian provincial associations, APA works to advance psychology as a science, as a profession and as a means of promoting human welfare.