Tools for measuring clinical effectiveness.

Efficacy studies fail to consider the multiple aspects of schizophrenia that determine the overall clinical effectiveness of treatment. We address this shortcoming by proposing definitions of six schizophrenia outcome domains which we believe contribute to clinical effectiveness: symptoms of disease, tolerability, everyday functioning, subjective well-being, family/career burden, and treatment adherence. Numerous specialised rating scales are in widespread use; however, these only assess specific aspects of schizophrenia within individual domains and are of limited use for measuring clinical effectiveness. New rating instruments that measure treatment outcomes across all six domains of schizophrenia need to be developed. One such scale is the revised Global Outcome Assessment of Life in Schizophrenia (GOALS) scale. We propose that further development of this scale should include validation in long-term studies, incorporation of the patient perspective of treatment within assessments, and education of clinicians on how to score this scale. If this approach to evaluating treatment outcomes is adopted, clinicians will be better placed to differentiate therapeutic interventions on the basis of clinical effectiveness.