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Haun MW, van Eickels D, Tönnies J, Graue L, Ayoub-Schreifeldt M, Wensing M, Hartmann M, Szecsenyi J, Wild B, Friederich HC. An integrated mental health video consultations model for patients with somatic symptom disorder in primary care: The randomized VISION pilot trial. J Psychosom Res 2024; 182:111801. [PMID: 38761536 DOI: 10.1016/j.jpsychores.2024.111801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 04/16/2024] [Accepted: 05/12/2024] [Indexed: 05/20/2024]
Abstract
OBJECTIVE Symptoms of somatic symptom disorder (SSD) are one of the most common reasons for consultations in primary care. However, specialized psychological services are mostly unavailable. This pilot trial aimed to determine the feasibility, acceptability, and safety of the integrated mental health video consultations VISION model for patients with SSD in primary care. METHODS We conducted a parallel group, randomized controlled pilot trial involving fifty-one patients with SSD from ten primary care practices in Germany, who we randomized to the VISION model or enhanced treatment-as-usual (eTAU). The VISION model comprised five video consultations which featured diagnostic clarification, psychoeducation (acknowledging and legitimizing of symptoms), and brief psychological therapy. eTAU included training primary care practice teams on the DSM-5 concept of SSD and on current guideline recommendations for its treatment in primary care. We assessed feasibility as the primary outcome at 6-months, measuring efficiency of recruitment, intervention acceptability, and safety. RESULTS Recruitment was efficient reflected in an overall recruitment yield (number randomized per number screened) of 55% (51/92) and a consent rate (number randomized per number eligible) of 94% (51/54). Acceptability of the intervention was high with 98% (123/125) of the video consultations conducted as planned. No serious adverse events were reported in either group. CONCLUSION An integrated mental health video consultations VISION model for patients with SSD presenting to primary care is feasible, acceptable, and safe. Potential clinical effectiveness of the model should be evaluated in confirmatory trial implementing the multifaceted approach tailored to the individual patient with SSD directly into primary care practice. TRIAL REGISTRATION The trial protocol was registered at German Clinical Trials Register (number: DRKS00026075, https://www.drks.de).
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Affiliation(s)
- Markus W Haun
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Germany.
| | - Deborah van Eickels
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Germany
| | - Justus Tönnies
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Germany
| | - Leike Graue
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Germany
| | | | - Michel Wensing
- Department of General Practice and Health Services Research, Heidelberg University, Germany
| | - Mechthild Hartmann
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Germany
| | - Joachim Szecsenyi
- Department of General Practice and Health Services Research, Heidelberg University, Germany
| | - Beate Wild
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Germany
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Arens EA, Donnerstag L, Hofmann SG, Stangier U. [Video-Based Online Metta-Meditation Therapy for Depression: A Pilot Trial Evaluating the Acceptability and Feasibility]. VERHALTENSTHERAPIE 2024; 34:32-43. [PMID: 38645510 PMCID: PMC11025693 DOI: 10.1159/000534381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 09/28/2023] [Indexed: 04/23/2024]
Abstract
Background In the course of the Covid-19 pandemic, it has become clear what relevance non-contact psychotherapeutic online interventions in mental health care could possibly have in the future. The present pilot study aims to test whether a Metta-based group program is also an acceptable and feasible treatment when conducted as video-based intervention. Metta meditations aim at showing unconditional benevolence and kindness to oneself and to other people. Methods Eight patients with depressive disorder participated in a video-based implementation of the Metta-based group program. Quality of the therapeutic relationship, the implementation of methods as well as the acceptance of the video-based therapy on the part of the participants were surveyed as target variables. Results Data indicated good feasibility in terms of a sustainable therapeutic relationship, the possibility of teaching meditation techniques, and the establishment of a concentrated working atmosphere. Videobased therapy met with good acceptance among the participants. Potential indications for its clinical effectiveness are evident. Conclusion Teaching Metta meditation in a group program for the treatment of depression can be practicably implemented in a video-based therapy and meets with good acceptance by the patients. Further studies on moderators of acceptance and efficacy of video-based therapy are needed.
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Affiliation(s)
- Elisabeth A. Arens
- Abteilung für Klinische Psychologie und Psychotherapie, Goethe-Universität Frankfurt, Frankfurt am Main, Deutschland
| | - Lucas Donnerstag
- Abteilung für Klinische Psychologie und Psychotherapie, Goethe-Universität Frankfurt, Frankfurt am Main, Deutschland
| | - Stefan G. Hofmann
- Abteilung für Klinische Psychologie und Psychotherapie, Philipps-Universität Marburg, Marburg, Deutschland
- Department of Psychological and Brain Sciences, Boston University, Boston, Massachusetts, USA
| | - Ulrich Stangier
- Abteilung für Klinische Psychologie und Psychotherapie, Goethe-Universität Frankfurt, Frankfurt am Main, Deutschland
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Haun MW, Oeljeklaus L, Hoffmann M, Tönnies J, Wensing M, Szecsenyi J, Peters-Klimm F, Krisam R, Kronsteiner D, Hartmann M, Friederich HC. Primary care patients' experiences of video consultations for depression and anxiety: a qualitative interview study embedded in a randomized feasibility trial. BMC Health Serv Res 2023; 23:9. [PMID: 36600264 PMCID: PMC9811759 DOI: 10.1186/s12913-022-09012-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 12/26/2022] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Integrated mental health care models that provide rapid access to video consultations with mental health specialists for primary care patients are a promising short-term, low-threshold treatment option and may reduce waiting times for specialist care. This qualitative study, nested within a randomized feasibility trial, aimed to explore participants' views on this type of care model, its influence on the lived experience of patients, and barriers and facilitators for its delivery. METHODS In five primary care practices, 50 adults with depression and/or anxiety were randomly assigned to either an integrated care model (maximum of five video consultations with a mental health specialist) or usual care (primary care or another treatment option). Prior to obtaining the trial results, interviews were held with participants who had received video consultations. Interviews were transcribed and analysed thematically. RESULTS Twenty of the 23 patients who received video consultations participated in the interviews. Patients engaged well with the care model and reported positive effects on their most pressing needs, while denying safety concerns. Generally, they perceived the usability of video consultations as high, and temporary connectivity failures were not considered a substantial barrier. We identified two key mechanisms of impacts on the patients' lived experience: fast access to specialist mental healthcare and the emerging rapport with the specialist. In particular, patients with no prior mental healthcare experience indicated that familiarity with the primary practice and their physician as a gatekeeper were important facilitators of proactive treatment. CONCLUSIONS From the patients' perspective, mental health care models integrating video consultations with mental health specialists into primary care are linked to positive lived experiences. Our findings imply that primary care physicians should promote their role as gatekeepers to (1) actively engage patients, (2) apply integrated care models to provide a familiar and safe environment for conducting mental health care video consultations, and (3) be able to regularly assess whether certain patients need in-person services. Scaling up such models may be worthwhile in real-world service settings, where primary care physicians are faced with high workloads and limited specialist services. TRIAL REGISTRATION DRKS00015812.
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Affiliation(s)
- Markus W. Haun
- grid.7700.00000 0001 2190 4373Department of General Internal Medicine and Psychosomatics, Heidelberg University, Im Neuenheimer Feld 410, D-69120 Heidelberg, Germany
| | - Lydia Oeljeklaus
- grid.7700.00000 0001 2190 4373Department of General Internal Medicine and Psychosomatics, Heidelberg University, Im Neuenheimer Feld 410, D-69120 Heidelberg, Germany
| | - Mariell Hoffmann
- grid.7700.00000 0001 2190 4373Department of General Internal Medicine and Psychosomatics, Heidelberg University, Im Neuenheimer Feld 410, D-69120 Heidelberg, Germany
| | - Justus Tönnies
- grid.7700.00000 0001 2190 4373Department of General Internal Medicine and Psychosomatics, Heidelberg University, Im Neuenheimer Feld 410, D-69120 Heidelberg, Germany
| | - Michel Wensing
- grid.7700.00000 0001 2190 4373Department of General Practice and Health Services Research, Heidelberg University, Heidelberg, Germany
| | - Joachim Szecsenyi
- grid.7700.00000 0001 2190 4373Department of General Practice and Health Services Research, Heidelberg University, Heidelberg, Germany
| | - Frank Peters-Klimm
- grid.7700.00000 0001 2190 4373Department of General Practice and Health Services Research, Heidelberg University, Heidelberg, Germany
| | - Regina Krisam
- grid.7700.00000 0001 2190 4373Institute of Medical Biometry and Informatics, Heidelberg University, Heidelberg, Germany
| | - Dorothea Kronsteiner
- grid.7700.00000 0001 2190 4373Institute of Medical Biometry and Informatics, Heidelberg University, Heidelberg, Germany
| | - Mechthild Hartmann
- grid.7700.00000 0001 2190 4373Department of General Internal Medicine and Psychosomatics, Heidelberg University, Im Neuenheimer Feld 410, D-69120 Heidelberg, Germany
| | - Hans-Christoph Friederich
- grid.7700.00000 0001 2190 4373Department of General Internal Medicine and Psychosomatics, Heidelberg University, Im Neuenheimer Feld 410, D-69120 Heidelberg, Germany
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Haun MW, Tönnies J, Graue L, Hartmann M, Wensing M, Szecsenyi J, Wild B, Friederich HC. Mental health specialist video consultations for patients with somatic symptom disorder in primary care: protocol for a randomised feasibility trial (the VISION trial). BMJ Open 2022; 12:e058150. [PMID: 35410935 PMCID: PMC9003599 DOI: 10.1136/bmjopen-2021-058150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION General practitioners (GP) report increasing difficulties in referring patients with somatic symptom disorder (SSD) in specialised psychosocial care. Barriers are structural conditions of the respective healthcare system and patients' reservations against receiving specialised psychosocial care. As patients with SSD often predominantly assume somatic influencing factors for the development and maintenance of their somatic complaints, close collaboration between the GP and mental health specialist (MHS) seems particularly important. Integrating internet-based video consultations by remotely located MHS and primary care can improve effective treatment of patients with SSD by overcoming structural barriers and provide low-threshold and timely care. The aim of this randomised controlled feasibility trial is to investigate the feasibility of implementing MHS video consultations in primary care practices. METHODS AND ANALYSIS Fifty primary care patients with SSD will be individually randomised in two groups receiving either enhanced treatment as usual as provided by their GP (control group) or two versus five video consultations conducted by an MHS additionally to enhanced treatment as usual. The video consultations focus on (a) diagnostic clarification, (b) the development of a biopsychosocial disorder model, and (c) development of a treatment plan against the background of a stepped-care algorithm based on clinical outcomes. We will investigate the following outcomes: effectiveness of the recruitment strategies, patient acceptance of randomisation, practicability of the technical and logistical processes related to implementing video consultations in the practices' workflows, feasibility of the data collection and clinical parameters. ETHICS AND DISSEMINATION This trial has undergone ethical scrutiny and has been approved by the Medical Faculty of the University of Heidelberg Ethics Committee (S-620/2021). The findings will be disseminated to the research community through presentations at conferences and publications in scientific journals. This feasibility trial will prepare the ground for a large-scale, fully powered randomised controlled trial. TRIAL REGISTRATION NUMBER DRKS00026075.
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Affiliation(s)
- Markus W Haun
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Heidelberg, Germany
| | - Justus Tönnies
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Heidelberg, Germany
| | - Leike Graue
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Heidelberg, Germany
| | - Mechthild Hartmann
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Heidelberg, Germany
| | - Michel Wensing
- Department of General Practice and Health Services Research, Heidelberg University, Heidelberg, Germany
| | - Joachim Szecsenyi
- Department of General Practice and Health Services Research, Heidelberg University, Heidelberg, Germany
| | - Beate Wild
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Heidelberg, Germany
| | - Hans-Christoph Friederich
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Heidelberg, Germany
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Rene R, Cherson M, Rannazzisi A, Felter J, Silverio A, Cunningham AT. Transitioning from In-Person to Telemedicine Within Primary Care Behavioral Health During COVID-19. Popul Health Manag 2022; 25:455-461. [PMID: 35196130 DOI: 10.1089/pop.2021.0292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The COVID-19 pandemic created significant mental stressors among patients, which had the potential to impede access to primary care behavioral health (PCBH) services through rapid unplanned shifts to telehealth. The authors utilized retrospective administrative data and patient surveys to assess the feasibility, acceptability, and clinical outcomes of Jefferson Health PCBH pre- and post-COVID pandemic onset (Cohort 1 in person-only visits and Cohort 2 telemedicine-only visits). Using a retrospective cohort comparison study, outcomes included number of patients receiving PCBH in both cohorts, frequency of visits, no-show and cancellation rates, change in mean PHQ-9 and GAD-7 scores for patients, changes in the levels of depression and anxiety severity using established severity levels, and patient satisfaction with telehealth (Cohort 2 only). Patients in Cohort 2 were significantly more likely to have an anxiety diagnosis, had a smaller average number of visits, and were more likely to have a cancelled appointment. Both cohorts had statistically significant improvements in PHQ-9 and GAD-7 scores. In regression analyses, treatment cohort was not a significant predictor of final PHQ-9 or GAD-7 score. More members of Cohort 2 reported severe anxiety at both initial and final measurements. Nearly all Cohort 2 patients agreed or strongly agreed that telehealth made it easier for them to obtain care, that the platform was easy to use, and the visit was effective. Overall, PCBH telehealth services post-COVID-19 onset were feasible, acceptable to patients, and yielded similar clinical improvements to in-person behavioral health visits conducted before the pandemic.
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Affiliation(s)
- Rachelle Rene
- Department of Psychiatry and Human Behavior, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.,Department of Family and Community Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.,Department of Comprehensive Primary Care Plus, Population Health, Jefferson Health
| | - Mollie Cherson
- Department of Psychiatry and Human Behavior, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.,Department of Comprehensive Primary Care Plus, Population Health, Jefferson Health
| | - Angelo Rannazzisi
- Department of Psychiatry and Human Behavior, Thomas Jefferson University, Philadelphia, Pennsylvania, USA.,Department of Comprehensive Primary Care Plus, Population Health, Jefferson Health
| | - Jeanne Felter
- Department of Counseling and Behavioral Health, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Alexis Silverio
- Department of Family and Community Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Amy T Cunningham
- Department of Family and Community Medicine, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Alwadei A, Alnanih R. Designing a Tool to Address the Depression of Children During Online Education. PROCEDIA COMPUTER SCIENCE 2022; 203:173-180. [PMID: 35974963 PMCID: PMC9374316 DOI: 10.1016/j.procs.2022.07.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Advances in communication and information technology have changed the way humans interact. During the COVID-19 pandemic, the technology for communication has caused depression and anxiety, including among children and teens. Depression among children and teens may go unrecognized and untreated, as parents and teachers may have difficulty recognizing the symptoms. COVID-19 has changed traditional learning methods, forcing children to stay home and connect through online education. Although some children may function reasonably well in less-structured environments, many children with significant depression suffer a noticeable change in social activities, loss of interest in an online school, poor online academic performance, or changes in appearance. Home quarantine has affected children's mental health, and it has become challenging for school counselors to predict depression in many children participating in online education. This study aims to design and develop a tool for predicting depression among children aged 7 to 9 years old by recording students' online classes and sending a note to the child's academic file. The idea of needing this tool arose as an output for applying the design thinking approach to the online education website during COVID-19. This inspired the authors to combine the lecture recordings and the prediction of depression into one tool. Image processing techniques are applied to generate the results predicted by the model on the collected videos. The overall accuracy for classifying depressed and not depressed videos is 89%.
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Affiliation(s)
- Asma Alwadei
- Department of Computer Science, Faculty of Computing and Information Technology King Abdulaziz University, Jeddah, Saudi Arabia
| | - Reem Alnanih
- Department of Computer Science, Faculty of Computing and Information Technology King Abdulaziz University, Jeddah, Saudi Arabia
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Haun MW, Hoffmann M, Wildenauer A, Tönnies J, Wensing M, Szecsenyi J, Peters-Klimm F, Krisam R, Kronsteiner D, Hartmann M, Friederich HC. Health providers' experiences with mental health specialist video consultations in primary care: a qualitative study nested within a randomised feasibility trial. BMJ Open 2021; 11:e047829. [PMID: 34753752 PMCID: PMC8578962 DOI: 10.1136/bmjopen-2020-047829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 10/21/2021] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE Despite available effective treatments for mental health disorders, few patients in need receive even the most basic care. Integrated telepsychiatry services may be a viable option to increase access to mental healthcare. The aim of this qualitative process evaluation embedded in a randomised controlled feasibility trial was to explore health providers' experiences with a mental healthcare model integrating mental health specialist video consultations (MHSVC) and primary care. METHODS A qualitative process evaluation focusing on MHSVC in primary care was conducted. In 13 semistructured interviews, we assessed the experience of all mental health specialists, primary care physicians and medical assistants who participated in the trial. A thematic analysis, focusing on the implementation, mechanisms of impact and context, was applied to investigate the data. RESULTS Considering (1) the implementation, participants evaluated the consultations as feasible, easy to use and time saving. Concerning (2) the mechanisms of impact, the consultations were regarded as effective for patients. Providers attributed the patients' improvements to two key aspects: the familiarity of the primary care practice and the fast access to specialist mental healthcare. Mental health specialists observed trustful therapeutic alliances emerging and described their experience as comparable to same-room care. However, compared with same-room care, specialists perceived the video consultations as more challenging and sometimes more exhausting due to the additional effort required for establishing therapeutic alliances. Regarding (3) the intervention's context, shorter travel distances for patients positively affected the implementation, while technical failures, that is, poor Internet connectivity, emerged as the main barrier. CONCLUSIONS MHSVCs in primary care are feasible and successful in improving access to mental healthcare for patients. To optimise engagement and comfort of both patients and health providers, future work should focus on empirical determinants for establishing robust therapeutic alliances with patients receiving MHSVC (eg, leveraging non-verbal cues for therapeutic purposes). TRIAL REGISTRATION NUMBER DRKS00015812; Results.
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Affiliation(s)
- Markus W Haun
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Heidelberg, Baden-Württemberg, Germany
| | - Mariell Hoffmann
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Heidelberg, Baden-Württemberg, Germany
| | - Alina Wildenauer
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Heidelberg, Baden-Württemberg, Germany
| | - Justus Tönnies
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Heidelberg, Baden-Württemberg, Germany
| | - Michel Wensing
- Department of General Practice and Health Services Research, Heidelberg University, Heidelberg, Baden-Württemberg, Germany
| | - Joachim Szecsenyi
- Department of General Practice and Health Services Research, Heidelberg University, Heidelberg, Baden-Württemberg, Germany
| | - Frank Peters-Klimm
- Department of General Practice and Health Services Research, Heidelberg University, Heidelberg, Baden-Württemberg, Germany
| | - Regina Krisam
- Institute of Medical Biometry and Informatics, Heidelberg University, Heidelberg, Baden-Württemberg, Germany
| | - Dorothea Kronsteiner
- Institute of Medical Biometry and Informatics, Heidelberg University, Heidelberg, Baden-Württemberg, Germany
| | - Mechthild Hartmann
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Heidelberg, Baden-Württemberg, Germany
| | - Hans-Christoph Friederich
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Heidelberg, Baden-Württemberg, Germany
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Tönnies J, Oeljeklaus L, Wensing M, Hartmann M, Friederich HC, Haun MW. Health policy experts' perspectives on implementing mental health specialist video consultations in routine primary care - a qualitative interview study. BMC Health Serv Res 2021; 21:713. [PMID: 34284786 PMCID: PMC8293503 DOI: 10.1186/s12913-021-06676-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Accepted: 06/22/2021] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Many patients with mental disorders are treated by their general practitioner (GP). Innovative technology-based integrated care models (e.g., mental health specialist video consultations) have been proposed to facilitate access to specialist services in primary care settings. While perspectives of patients and providers have been examined, there is little insight into the perspectives of health policy experts on such models. The purpose of this study was to examine the perspectives of health policy experts on (1) current challenges for continuity of care, (2) anticipated benefits and barriers for implementation of mental health specialist video consultations along with (3) practical and regulative preconditions for sustained implementation in primary care. METHODS In a cross-sectional qualitative study, we conducted 15 semi-structured interviews with health policy experts representing various stakeholders in the German health care system: health insurances, governmental bodies, clinicians' professional associations, and patient representatives. Following a critical realism approach, we applied a qualitative inductive content analysis to derive key themes from the material. RESULTS Health policy experts saw long waiting times for patients and a lack of collaboration between in- and outpatient mental health services as well as mental health specialists and GPs as main barriers for current continuity of care. Health policy experts also felt that video consultations bear great potential to foster coordinated care between GPs and specialists and ensure timely referral for severely burdened patients. Increased workload for the general practice staff to facilitate video consultations and difficulties in establishing reliable therapeutic alliances between patients and specialists via remote treatment were considered as major barriers. Health policy experts varied significantly in their level of knowledge concerning legal frameworks and regulations pertaining to video consultations. However, the implementation of appropriate reimbursement schemes and sufficient data protection were regarded as the major regulative challenges. CONCLUSIONS Health policy experts mostly consider mental health specialist video consultations as a promising way to overcome current challenges for the management of patients with mental disorders at the interface between primary and specialist care. To ensure sustained implementation, a multi-stakeholder approach accounting for the perspective of health policy experts, patients, and providers should be followed. TRIAL REGISTRATION German Clinical Trials Register DRKS00012487.
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Affiliation(s)
- Justus Tönnies
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Lydia Oeljeklaus
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Michel Wensing
- Department of General Practice and Health Services Research, Heidelberg University, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
| | - Mechthild Hartmann
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Hans-Christoph Friederich
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany
| | - Markus W Haun
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Im Neuenheimer Feld 410, 69120, Heidelberg, Germany.
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Haun MW, Tönnies J, Krisam R, Kronsteiner D, Wensing M, Szecsenyi J, Vomhof M, Icks A, Wild B, Hartmann M, Friederich HC. Mental health specialist video consultations versus treatment as usual in patients with depression or anxiety disorders in primary care: study protocol for an individually randomised superiority trial (the PROVIDE-C trial). Trials 2021; 22:327. [PMID: 33952313 PMCID: PMC8097128 DOI: 10.1186/s13063-021-05289-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Accepted: 04/23/2021] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Most people with mental disorders, including those with severe and chronic disorders, are treated solely by their general practitioner (GP). Nevertheless, specialised mental health care may be required for specific patients. Notably, the accessibility of mental health specialist care is mainly complicated by (a) long waiting times for an appointment with specialists, (b) long travel distances to specialists, particularly in rural and remote areas, and (c) patients' reservations about mental health specialist care (including fear of being stigmatised by seeking such care). To mitigate those barriers, technology-based integrated care models have been proposed. The purpose of this study is to examine the effectiveness and cost-effectiveness of a mental health specialist video consultations model versus treatment as usual in patients with depression or anxiety disorders in primary care. METHODS In an individually randomised, prospective, two-arm superiority trial with parallel group design, N = 320 patients with anxiety and/or depressive disorder will be recruited in general practices in Germany. The intervention includes a newly developed treatment model based on video consultations with focus on diagnostics, treatment planning, and short-term intervention by mental health specialists. We will systematically compare the effectiveness, cost-effectiveness, and adverse effects of this new model with usual care by the GP: the primary outcome is the absolute change in the mean depressive and anxiety symptom severity measured on the Patient Health Questionnaire Anxiety and Depression Scale (PHQ-ADS) from baseline to 6 months after baseline assessment. Follow-up in both groups will be conducted by blinded outcome assessors at 6 months and 12 months after baseline. The main analysis will be based on the intention-to-treat principle. We will optimise the likelihood of treatment effectiveness by strict inclusion criteria for patients, enhanced intervention integrity, and conducting a process evaluation. DISCUSSION To the best of our knowledge, this is the first confirmatory study on a video-based, integrated care model for the treatment of anxiety and depressive disorders in GP patients in Germany. TRIAL REGISTRATION ClinicalTrials.gov, United States National Institutes of Health NCT04316572 . Prospectively registered on 20 March 2020.
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Affiliation(s)
- Markus W Haun
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Im Neuenheimer Feld 410, D-69120, Heidelberg, Germany.
| | - Justus Tönnies
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Im Neuenheimer Feld 410, D-69120, Heidelberg, Germany
| | - Regina Krisam
- Institute of Medical Biometry and Informatics (IMBI), Heidelberg University, Heidelberg, Germany
| | - Dorothea Kronsteiner
- Institute of Medical Biometry and Informatics (IMBI), Heidelberg University, Heidelberg, Germany
| | - Michel Wensing
- Department of General Practice and Health Services Research, Heidelberg University, Heidelberg, Germany
| | - Joachim Szecsenyi
- Department of General Practice and Health Services Research, Heidelberg University, Heidelberg, Germany
| | - Markus Vomhof
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich-Heine-University, Düsseldorf, Germany
- Institute for Health Services Research and Health Economics, German Diabetes Centre, Düsseldorf, Germany
| | - Andrea Icks
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Faculty of Medicine, Heinrich-Heine-University, Düsseldorf, Germany
- Institute for Health Services Research and Health Economics, German Diabetes Centre, Düsseldorf, Germany
| | - Beate Wild
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Im Neuenheimer Feld 410, D-69120, Heidelberg, Germany
| | - Mechthild Hartmann
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Im Neuenheimer Feld 410, D-69120, Heidelberg, Germany
| | - Hans-Christoph Friederich
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Im Neuenheimer Feld 410, D-69120, Heidelberg, Germany
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Tönnies J, Hartmann M, Wensing M, Szecsenyi J, Peters-Klimm F, Brinster R, Weber D, Vomhof M, Icks A, Friederich HC, Haun MW. Mental Health Specialist Video Consultations Versus Treatment-as-Usual for Patients With Depression or Anxiety Disorders in Primary Care: Randomized Controlled Feasibility Trial. JMIR Ment Health 2021; 8:e22569. [PMID: 33709931 PMCID: PMC7998325 DOI: 10.2196/22569] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 11/13/2020] [Accepted: 01/29/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Most people affected by depression or anxiety disorders are treated solely by their primary care physician. Access to specialized mental health care is impeded by patients' comorbidity and immobility in aging societies and long waiting times at the providers' end. Video-based integrated care models may leverage limited resources more efficiently and provide timely specialized care in primary care settings. OBJECTIVE The study aims to evaluate the feasibility of mental health specialist video consultations with primary care patients with depression or anxiety disorders. METHODS Participants were recruited by their primary care physicians during regular practice visits. Patients who had experienced at least moderate symptoms of depression and/or anxiety disorders were considered eligible for the study. Patients were randomized into 2 groups receiving either treatment-as-usual as provided by their general practitioner or up to 5 video consultations conducted by a mental health specialist. Video consultations focused on systematic diagnosis and proactive monitoring using validated clinical rating scales, the establishment of an effective working alliance, and a stepped-care algorithm within integrated care adjusting treatments based on clinical outcomes. Feasibility outcomes were recruitment, rate of loss to follow-up, acceptability of treatment, and attendance at sessions. Effectiveness outcomes included depression (Patient Health Questionnaire-9), anxiety (Generalized Anxiety Disorder-7), burden of specific somatic complaints (Somatic Symptom Disorder-B Criteria Scale-12), recovery (Recovery Assessment Scale-German [RAS-G]), and perception of chronic illness care (Patient Assessment of Chronic Illness Care), which were measured at baseline and 16 weeks postallocation by assessors blinded to the group allocation. RESULTS A total of 50 patients with depression and/or anxiety disorders were randomized, 23 in the intervention group and 27 in the treatment-as-usual group. The recruitment yield (number randomized per number screened) and the consent rate (number randomized per number eligible) were 69% (50/73) and 86% (50/58), respectively. Regarding acceptability, 87% (20/23) of the participants in the intervention group completed the intervention. Of the 108 planned video consultations, 102 (94.4%) were delivered. Follow-up rates were 96% (22/23) and 85% (23/27) for the intervention and control groups, respectively. The change from baseline scores at postmeasurement for the No Domination by Symptoms domain of recovery (RAS-G) was somewhat higher in the intervention group than in the control group (Mann-Whitney U test: rank-biserial r=0.19; 95% CI -0.09 to 0.46; P=.18). We did not detect any notable differences between the intervention and control groups in terms of other effectiveness outcomes. We did not observe any serious adverse events related to the trial. CONCLUSIONS The intervention and study procedures were found to be feasible for patients, primary care practice staff, and mental health specialists. A sufficiently powered pragmatic trial on mental health specialist video consultations should be conducted to investigate their effectiveness in routine care. TRIAL REGISTRATION German Clinical Trials Register DRKS00015812; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00015812.
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Affiliation(s)
- Justus Tönnies
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Heidelberg, Germany
| | - Mechthild Hartmann
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Heidelberg, Germany
| | - Michel Wensing
- Department of General Practice and Health Services Research, Heidelberg University, Heidelberg, Germany
| | - Joachim Szecsenyi
- Department of General Practice and Health Services Research, Heidelberg University, Heidelberg, Germany
| | - Frank Peters-Klimm
- Department of General Practice and Health Services Research, Heidelberg University, Heidelberg, Germany
| | - Regina Brinster
- Institute of Medical Biometry and Informatics, Heidelberg University, Heidelberg, Germany
| | - Dorothea Weber
- Institute of Medical Biometry and Informatics, Heidelberg University, Heidelberg, Germany
| | - Markus Vomhof
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Heinrich-Heine-University, Düsseldorf, Düsseldorf, Germany
| | - Andrea Icks
- Institute for Health Services Research and Health Economics, Centre for Health and Society, Heinrich-Heine-University, Düsseldorf, Düsseldorf, Germany
| | - Hans-Christoph Friederich
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Heidelberg, Germany
| | - Markus W Haun
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Heidelberg, Germany
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Lüchau EC, Jepsen C, Grønning A, Hvidt EA. Reciprocal dynamics between patients' choice of place and how they experience video consultations: A qualitative study. Digit Health 2021; 7:20552076211052158. [PMID: 34733540 PMCID: PMC8559177 DOI: 10.1177/20552076211052158] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 09/22/2021] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To analyse the reciprocal dynamics between patients' choice of place and how they experience video consultations (VCs) with the general practitioner. METHODS Qualitative, semi-structured interviews with 27 Danish patients were conducted over a period of 9 months, from February to October 2020. Interviews were analysed using thematic analysis. The analysis was guided by Nelly Oudshoorn's concept of technogeography of care. RESULTS The following three themes were identified in the data: VC-home dynamics: balancing boundaries; VC-workplace dynamics: logistical considerations; and VC-body image dynamics: on-screen exposure. CONCLUSIONS Taking human geography and science and technology studies as our analytical point of departure, we used the concept of technogeography of care and demonstrated how the reciprocal dynamics between patients' choice of place and how they experience VC made boundaries fluid and complex between different contexts and places, such as the home, the workplace and the clinic. These boundaries were negotiated differently by the patients depending on their need for privacy, convenience and support. Additionally, VC reconfigured patients' and general practitioners' roles, increasing patients' responsibility in securing an appropriate health care setting.
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Affiliation(s)
- Elle C. Lüchau
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
| | - Carole Jepsen
- Department for the Study of Culture, University of Southern Denmark, Odense, Denmark
| | - Anette Grønning
- Department for the Study of Culture, University of Southern Denmark, Odense, Denmark
| | - Elisabeth Assing Hvidt
- Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark
- Department for the Study of Culture, University of Southern Denmark, Odense, Denmark
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Haun MW, Stephan I, Wensing M, Hartmann M, Hoffmann M, Friederich HC. Intent to Adopt Video-Based Integrated Mental Health Care and the Characteristics of its Supporters: Mixed Methods Study Among General Practitioners Applying Diffusion of Innovations Theory. JMIR Ment Health 2020; 7:e23660. [PMID: 33055058 PMCID: PMC7654505 DOI: 10.2196/23660] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 09/11/2020] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Most people with common mental disorders, including those with severe mental illness, are treated in general practice. Video-based integrated care models featuring mental health specialist video consultations (MHSVC) facilitate the involvement of specialist mental health care. However, the potential uptake by general practitioners (GPs) is unclear. OBJECTIVE This mixed method preimplementation study aims to assess GPs' intent to adopt MHSVC in their practice, identify predictors for early intent to adopt (quantitative strand), and characterize GPs with early intent to adopt based on the Diffusion of Innovations Theory (DOI) theory (qualitative strand). METHODS Applying a convergent parallel design, we conducted a survey of 177 GPs and followed it up with focus groups and individual interviews for a sample of 5 early adopters and 1 nonadopter. We identified predictors for intent to adopt through a cumulative logit model for ordinal multicategory responses for data with a proportional odds structure. A total of 2 coders independently analyzed the qualitative data, deriving common characteristics across the 5 early adopters. We interpreted the qualitative findings accounting for the generalized adopter categories of DOI. RESULTS This study found that about one in two GPs (87/176, 49.4%) assumed that patients would benefit from an MHSVC service model, about one in three GPs (62/176, 35.2%) intended to adopt such a model, the availability of a designated room was the only significant predictor of intent to adopt in GPs (β=2.03, SE 0.345, P<.001), supporting GPs expected to save time and took a solution-focused perspective on the practical implementation of MHSVC, and characteristics of supporting and nonsupporting GPs in the context of MHSVC corresponded well with the generalized adopter categories conceptualized in the DOI. CONCLUSIONS A significant proportion of GPs may function as early adopters and key stakeholders to facilitate the spread of MHSVC. Indeed, our findings correspond well with increasing utilization rates of telehealth in primary care and specialist health care services (eg, mental health facilities and community-based, federally qualified health centers in the United States). Future work should focus on specific measures to foster the intention to adopt among hesitant GPs.
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Affiliation(s)
- Markus W Haun
- Department of General Medicine and Psychosomatics, Heidelberg University, Heidelberg, Germany
| | - Isabella Stephan
- Department of General Medicine and Psychosomatics, Heidelberg University, Heidelberg, Germany
| | - Michel Wensing
- Department of General Practice and Health Services Research, Heidelberg University, Heidelberg, Germany
| | - Mechthild Hartmann
- Department of General Medicine and Psychosomatics, Heidelberg University, Heidelberg, Germany
| | - Mariell Hoffmann
- Department of General Medicine and Psychosomatics, Heidelberg University, Heidelberg, Germany
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Hoffmann M, Wensing M, Peters-Klimm F, Szecsenyi J, Hartmann M, Friederich HC, Haun MW. Perspectives of Psychotherapists and Psychiatrists on Mental Health Care Integration Within Primary Care Via Video Consultations: Qualitative Preimplementation Study. J Med Internet Res 2020; 22:e17569. [PMID: 32554369 PMCID: PMC7333073 DOI: 10.2196/17569] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 03/18/2020] [Accepted: 04/03/2020] [Indexed: 12/13/2022] Open
Abstract
Background Many patients with mental disorders remain untreated. Video-based mental health care demonstrates comparable effectiveness to face-to-face treatments and is a promising mode for delivering specialized care within primary care. Nevertheless, professionals struggle with implementing video consultations in their daily practice. Specifically, little is known about mental health specialists’ acceptance of mental health video consultations in routine practice. The PROVIDE (ImPROving cross-sectoral collaboration between primary and psychosocial care: An implementation study on VIDEo consultations) project aims to improve cross-sectoral collaboration between primary and psychosocial care through implementing video consultations in primary care. To increase the uptake of video consultations, it is crucial to account for necessary prerequisites and to tailor interventions to the needs of the target group prior to implementation. Objective The aim of this study was to explore the acceptance of video consultations embedded in primary care from the perspectives of mental health specialists in Germany. Methods We conducted a qualitative, exploratory, preimplementation study in urban and rural counties. We conducted three semistructured focus groups with 11 mental health specialists. We used qualitative content analysis combining an inductive-deductive approach, applying the Tailored Implementation in Chronic Diseases (TICD) framework to the text material, which comprises individual health professional factors; patient factors; professional interactions; incentives and resources; capacity for organizational change; social, political, and legal factors; and guideline factors. Results Against the background of long waiting times and a shortage of mental health specialists, especially in rural areas, participants valued video consultations as a potential means to improve access to mental health care. With respect to the TICD framework domains, the participants most often discussed individual health professional factors, followed by patient factors. All participants highlighted the importance of a trusting relationship between the patient and the therapist and doubted whether such a relationship could be established through video consultations (11/11, 100%). However, participants considered mental health specialist video consultations to be particularly suited for patients in rural areas, those with impaired mobility, and those who may otherwise remain untreated (6/11, 55%). Most participants expected video consultations to help the aforementioned patient groups avoid tedious searching for an available therapist and save on travel time and, therefore, improve access to specialized care for patients (7/11, 64%). Moreover, the participants expected video consultations to improve collaboration with the family physician (6/11, 55%). Finally, participants identified organizational aspects, such as reliable scheduling, the duration of the individual consultation (9/11, 82%), and reimbursement conditions (7/11, 67%), as key drivers for the acceptance and adoption of the model. Conclusions While mental health specialists expect video consultations to improve access to specialized care for some patients, they consistently wonder whether such consultations can establish a trusting patient-therapist relationship. When implementing video consultations, these concerns should be addressed by training providers in managing technology-based treatment settings, with extra consideration for fostering the patients’ and therapists’ engagement. Trial Registration German Clinical Trials Register DRKS00012487; https://tinyurl.com/uhg2one
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Affiliation(s)
- Mariell Hoffmann
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Heidelberg, Germany
| | - Michel Wensing
- Department of General Practice and Health Services Research, Heidelberg University, Heidelberg, Germany
| | - Frank Peters-Klimm
- Department of General Practice and Health Services Research, Heidelberg University, Heidelberg, Germany
| | - Joachim Szecsenyi
- Department of General Practice and Health Services Research, Heidelberg University, Heidelberg, Germany
| | - Mechthild Hartmann
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Heidelberg, Germany
| | - Hans-Christoph Friederich
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Heidelberg, Germany
| | - Markus W Haun
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Heidelberg, Germany
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Haun MW, Hoffmann M, Tönnies J, Dinger U, Hartmann M, Friederich HC. [Realtime video consultations by psychotherapists in times of the COVID-19 pandemic]. PSYCHOTHERAPEUT 2020; 65:291-296. [PMID: 32836895 PMCID: PMC7249972 DOI: 10.1007/s00278-020-00438-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Wegen der durch die „corona virus disease 2019“ (COVID-19) ausgelösten Pandemie und den resultierenden Beeinträchtigungen persönlicher (d. h. von Angesicht zu Angesicht stattfindender) Behandlung haben Videokonsultationen in der Erbringung von Gesundheitsleistungen massiv an Bedeutung zugenommen. Die meisten Psychotherapeuten haben allerdings bis dato wenig praktische Erfahrung in der Durchführung von Videokonsultationen, nicht zuletzt auch aufgrund bisher eingeschränkter Möglichkeiten zur Abrechnung mit den Kostenträgern. Der vorliegende Beitrag stellt (1) eine Übersicht über die Wirksamkeit per Videokonsultation durchgeführter psychotherapeutischer Interventionen bei depressiven und Angststörungen, (2) Empfehlungen zur spezifischen Gestaltung des Behandlungsrahmens sowie (3) erste Erfahrungen von Patienten und Psychotherapeuten aus einer deutschen Machbarkeitsstudie sowie mit dem Routineangebot im Krankenhaus während der COVID-19-Pandemie vor.
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Affiliation(s)
- Markus W Haun
- Klinik für Allgemeine Innere Medizin und Psychosomatik, Zentrum für Psychosoziale Medizin, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Deutschland
| | - Mariell Hoffmann
- Klinik für Allgemeine Innere Medizin und Psychosomatik, Zentrum für Psychosoziale Medizin, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Deutschland
| | - Justus Tönnies
- Klinik für Allgemeine Innere Medizin und Psychosomatik, Zentrum für Psychosoziale Medizin, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Deutschland
| | - Ulrike Dinger
- Klinik für Allgemeine Innere Medizin und Psychosomatik, Zentrum für Psychosoziale Medizin, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Deutschland
| | - Mechthild Hartmann
- Klinik für Allgemeine Innere Medizin und Psychosomatik, Zentrum für Psychosoziale Medizin, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Deutschland
| | - Hans-Christoph Friederich
- Klinik für Allgemeine Innere Medizin und Psychosomatik, Zentrum für Psychosoziale Medizin, Universitätsklinikum Heidelberg, Im Neuenheimer Feld 410, 69120 Heidelberg, Deutschland
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15
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Bleyel C, Hoffmann M, Wensing M, Hartmann M, Friederich HC, Haun MW. Patients' Perspective on Mental Health Specialist Video Consultations in Primary Care: Qualitative Preimplementation Study of Anticipated Benefits and Barriers. J Med Internet Res 2020; 22:e17330. [PMID: 32310139 PMCID: PMC7199141 DOI: 10.2196/17330] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 02/29/2020] [Accepted: 03/02/2020] [Indexed: 01/01/2023] Open
Abstract
Background Due to limited access to specialist services, most patients with common mental disorders (depression or anxiety, or both) usually receive treatment in primary care. More recently, innovative technology-based care models (eg, video consultations) have been proposed to facilitate access to specialist services. Against this background, the PROVIDE (Improving Cross-Sectoral Collaboration Between Primary and Psychosocial Care: An Implementation Study on Video Consultations) project aims to improve the provision of psychosocial care through implementing video consultations integrated into routine primary care. Objective From the patients’ perspective, this qualitative preimplementation study explored (1) anticipated benefits from and (2) barriers to implementing mental health specialist video consultations embedded in primary care services and (3) prerequisites for interacting with therapists via video consultations. Methods Using a purposive (ie, stratified) sampling strategy, we recruited 13 patients from primary care practices and a tertiary care hospital (psychosomatic outpatient clinic) for one-off semistructured interviews. In a computer-assisted thematic analysis, we inductively (bottom-up) derived key themes concerning the practicability of mental health specialist video consultations. To validate our results, we discussed our findings with the interviewees as part of a systematic member checking. Results Overall, we derived 3 key themes and 10 subthemes. Participants identified specific benefits in 2 areas: the accessibility of mental health specialist care (shorter waiting times: 11/13, 85%; lower threshold for seeking specialist mental health care: 6/13, 46%; shorter travel distances: 3/13, 23%); and the environment in primary care (familiar travel modalities, premises, and employees: 5/13, 38%). The main barriers to the implementation of mental health video consultations from the patients’ perspective were the lack of face-to-face contact (13/13, 100%) and technical challenges (12/13, 92%). Notably, participants’ prerequisites for interacting with therapists (12/13, 92%) did not seem to differ much from those concerning face-to-face contacts. Conclusions Mental health service users mostly welcomed mental health specialist video consultations in primary care. Taking a pragmatic stance, service users, who are often frustrated about uncoordinated care, particularly valued the embedment of the consultations in the familiar environment of the primary care practice. With respect to interventional studies and implementation, our findings underscore the need to minimize technical disruptions during video consultations and to ensure optimal resemblance to face-to-face settings (eg, by training therapists in consistently reacting to nonverbal cues). Trial Registration German Clinical Trials Register DRKS00012487; https://tinyurl.com/uhg2one
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Affiliation(s)
- Caroline Bleyel
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Heidelberg, Germany
| | - Mariell Hoffmann
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Heidelberg, Germany
| | - Michel Wensing
- Department of General Practice and Health Services Research, Heidelberg University, Heidelberg, Germany
| | - Mechthild Hartmann
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Heidelberg, Germany
| | - Hans-Christoph Friederich
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Heidelberg, Germany
| | - Markus W Haun
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Heidelberg, Germany
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Maehder K, Löwe B, Härter M, Heddaeus D, von dem Knesebeck O, Weigel A. Psychotherapists' perspectives on collaboration and stepped care in outpatient psychotherapy-A qualitative study. PLoS One 2020; 15:e0228748. [PMID: 32023303 PMCID: PMC7002019 DOI: 10.1371/journal.pone.0228748] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 01/21/2020] [Indexed: 01/10/2023] Open
Abstract
Objective Stepped and collaborative care with outpatient psychotherapy as one treatment step is guideline-recommended for mental health care. To date, the experiences and evaluation of psychotherapists regarding collaboration and stepped care have been neglected. In order to improve collaborative mental health care, this qualitative study aimed at identifying psychotherapists’ perspectives and needs within collaboration and stepped care. Methods Semi-structured qualitative interviews with 20 German outpatient psychotherapists were conducted and analyzed applying thematic analysis. The analysis was realized in a recursive process to first identify themes and then relate these themes back to the research questions with regard to collaboration and stepped care. Results Collaboration mainly took place in small networks, with general practitioners and psychiatrists as the most important partners and psychotherapists wishing to intensify collaboration. Main barriers for collaboration were seen in deficient resources and remuneration and in a perceived lack of esteem by other medical specialties. Stepped care was appreciated for intensified collaboration and low-threshold access to care. Doubts were cast on its implementation within current health care conditions, worries concerned a primacy of economic principles instead of patient-orientation. Among further needs, psychotherapists demanded increased knowledge about psychotherapy, especially among general practitioners. Conclusion Psychotherapists expressed ambivalent attitudes towards stepped and collaborative care, substantially influenced by health care conditions and the perceived own standing among care providers. Psychotherapists’ needs within stepped care comprise intensified collaboration, sufficient time, personal and financial resources for collaboration and opportunities for a constructive interprofessional dialogue.
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Affiliation(s)
- Kerstin Maehder
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
- * E-mail:
| | - Bernd Löwe
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Martin Härter
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Daniela Heddaeus
- Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Olaf von dem Knesebeck
- Department of Medical Sociology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Angelika Weigel
- Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
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Hoffmann M, Hartmann M, Wensing M, Friederich HC, Haun MW. Potential for Integrating Mental Health Specialist Video Consultations in Office-Based Routine Primary Care: Cross-Sectional Qualitative Study Among Family Physicians. J Med Internet Res 2019; 21:e13382. [PMID: 31429419 PMCID: PMC6718083 DOI: 10.2196/13382] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2019] [Revised: 06/18/2019] [Accepted: 07/21/2019] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Although real-time mental health specialist video consultations have been proposed as an effective care model for treating patients with mental health conditions in primary care, little is known about their integration into routine practice from the perspective of family physicians. OBJECTIVE This study aimed to determine the degree to which family physicians advocate that mental health specialist video consultations can be integrated into routine primary care, where most patients with mental health conditions receive treatment. METHODS In a cross-sectional qualitative study, we conducted 4 semistructured focus groups and 3 telephonic interviews in a sample of 19 family physicians from urban and rural districts. We conducted a qualitative content analysis applying the Tailored Implementation in Chronic Diseases framework in a combined bottom-up (data-driven) and top-down strategy for deriving key domains. RESULTS Family physicians indicated that mental health specialist video consultations are a promising and practical way to address the most pressing challenges in current practice, that is, to increase the accessibility and co-ordination of specialized care. Individual health professional factors were the most frequently discussed topics. Specifically, family physicians valued the anticipated clinical outcomes for patients and the anticipated resources set for the primary care practice as major facilitators (16/19, 84%). However, family physicians raised a concern regarding a lack of facial expressions and physical interaction (19/19, 100%), especially in emergency situations. Therefore, most family physicians considered a viable emergency plan for mental health specialist video consultations that clearly delineates the responsibilities and tasks of both family physicians and mental health specialists to be essential (11/19, 58%). Social, political, and legal factors, as well as guideline factors, were hardly discussed as prerequisites for individual family physicians to integrate mental health specialist video consultations into routine care. To facilitate the implementation of future mental health specialist video consultation models, we compiled a checklist of recommendations that covers (1) buy-in from practices (eg, emphasizing logistical and psychological relief for the practice), (2) the engagement of patients (eg, establishing a trusted patient-provider relationship), (3) the setup and conduct of consultations (eg, reliable emergency plans), and (4) the fostering of collaboration between family physicians and mental health specialists (eg, kick-off meetings to build trust). CONCLUSIONS By leveraging the primary care practice as a familiar environment for patients, mental health specialist video consultations provide timely specialist support and potentially lead to benefits for patients and more efficient processes of care. Integration should account for the determinants of practice as described by the family physicians. TRIAL REGISTRATION German Clinical Trials Register DRKS00012487; https://www.drks.de/drks_web/navigate.do? navigationId=trial.HTML&TRIAL_ID=DRKS00012487.
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Affiliation(s)
- Mariell Hoffmann
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Heidelberg, Germany
| | - Mechthild Hartmann
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Heidelberg, Germany
| | - Michel Wensing
- Department of General Practice and Health Services Research, Heidelberg University, Heidelberg, Germany
| | - Hans-Christoph Friederich
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Heidelberg, Germany
| | - Markus W Haun
- Department of General Internal Medicine and Psychosomatics, Heidelberg University, Heidelberg, Germany
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