1
|
Klein A, Clucas J, Krishnakumar A, Ghosh SS, Van Auken W, Thonet B, Sabram I, Acuna N, Keshavan A, Rossiter H, Xiao Y, Semenuta S, Badioli A, Konishcheva K, Abraham SA, Alexander LM, Merikangas KR, Swendsen J, Lindner AB, Milham MP. Remote Digital Psychiatry for Mobile Mental Health Assessment and Therapy: MindLogger Platform Development Study. J Med Internet Res 2021; 23:e22369. [PMID: 34762054 PMCID: PMC8663601 DOI: 10.2196/22369] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Revised: 02/03/2021] [Accepted: 03/16/2021] [Indexed: 01/23/2023] Open
Abstract
Background Universal access to assessment and treatment of mental health and learning disorders remains a significant and unmet need. There are many people without access to care because of economic, geographic, and cultural barriers, as well as the limited availability of clinical experts who could help advance our understanding and treatment of mental health. Objective This study aims to create an open, configurable software platform to build clinical measures, mobile assessments, tasks, and interventions without programming expertise. Specifically, our primary requirements include an administrator interface for creating and scheduling recurring and customized questionnaires where end users receive and respond to scheduled notifications via an iOS or Android app on a mobile device. Such a platform would help relieve overwhelmed health systems and empower remote and disadvantaged subgroups in need of accurate and effective information, assessment, and care. This platform has the potential to advance scientific research by supporting the collection of data with instruments tailored to specific scientific questions from large, distributed, and diverse populations. Methods We searched for products that satisfy these requirements. We designed and developed a new software platform called MindLogger, which exceeds the requirements. To demonstrate the platform’s configurability, we built multiple applets (collections of activities) within the MindLogger mobile app and deployed several of them, including a comprehensive set of assessments underway in a large-scale, longitudinal mental health study. Results Of the hundreds of products we researched, we found 10 that met our primary requirements with 4 that support end-to-end encryption, 2 that enable restricted access to individual users’ data, 1 that provides open-source software, and none that satisfy all three. We compared features related to information presentation and data capture capabilities; privacy and security; and access to the product, code, and data. We successfully built MindLogger mobile and web applications, as well as web browser–based tools for building and editing new applets and for administering them to end users. MindLogger has end-to-end encryption, enables restricted access, is open source, and supports a variety of data collection features. One applet is currently collecting data from children and adolescents in our mental health study, and other applets are in different stages of testing and deployment for use in clinical and research settings. Conclusions We demonstrated the flexibility and applicability of the MindLogger platform through its deployment in a large-scale, longitudinal, mobile mental health study and by building a variety of other mental health–related applets. With this release, we encourage a broad range of users to apply the MindLogger platform to create and test applets to advance health care and scientific research. We hope that increasing the availability of applets designed to assess and administer interventions will facilitate access to health care in the general population.
Collapse
Affiliation(s)
- Arno Klein
- MATTER Lab, Child Mind Institute, New York, NY, United States
| | - Jon Clucas
- MATTER Lab, Child Mind Institute, New York, NY, United States.,Computational Neuroimaging Lab, Child Mind Institute, New York, NY, United States
| | - Anirudh Krishnakumar
- MATTER Lab, Child Mind Institute, New York, NY, United States.,Université de Paris and INSERM U1284 SEED unit, Centre for Research and Interdisciplinarity (CRI), Paris, France.,ETH Library Lab, ETH Zurich and Citizen Science Centre, Zurich, Switzerland
| | - Satrajit S Ghosh
- McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, MA, United States.,Department of Otolaryngology - Head and Neck Surgery, Harvard Medical School, Cambridge, MA, United States
| | | | - Benjamin Thonet
- MATTER Lab, Child Mind Institute, New York, NY, United States.,Université de Paris and INSERM U1284 SEED unit, Centre for Research and Interdisciplinarity (CRI), Paris, France
| | - Ihor Sabram
- MATTER Lab, Child Mind Institute, New York, NY, United States
| | - Nino Acuna
- MATTER Lab, Child Mind Institute, New York, NY, United States
| | - Anisha Keshavan
- MATTER Lab, Child Mind Institute, New York, NY, United States.,Octave Bioscience, Menlo Park, CA, United States
| | - Henry Rossiter
- Computational Engineering, University of Texas at Austin, Austin, TX, United States
| | - Yao Xiao
- Center for the Developing Brain, Child Mind Institute, New York, NY, United States
| | - Sergey Semenuta
- MATTER Lab, Child Mind Institute, New York, NY, United States
| | | | - Kseniia Konishcheva
- MATTER Lab, Child Mind Institute, New York, NY, United States.,Université de Paris and INSERM U1284 SEED unit, Centre for Research and Interdisciplinarity (CRI), Paris, France
| | - Sanu Ann Abraham
- McGovern Institute for Brain Research, Massachusetts Institute of Technology, Cambridge, MA, United States
| | - Lindsay M Alexander
- Center for the Developing Brain, Child Mind Institute, New York, NY, United States
| | | | - Joel Swendsen
- National Center for Scientific Research, University of Bordeaux, EPHE PSL University, Bordeaux, France
| | - Ariel B Lindner
- Université de Paris and INSERM U1284 SEED unit, Centre for Research and Interdisciplinarity (CRI), Paris, France
| | - Michael P Milham
- Center for the Developing Brain, Child Mind Institute, New York, NY, United States.,Center for Biomedical Imaging and Neuromodulation, Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY, United States
| |
Collapse
|
2
|
Ashcroft R, Silveira J, Mckenzie K. A Qualitative Study on Incentives and Disincentives for Care of Common Mental Disorders in Ontario Family Health Teams. Healthc Policy 2016; 12:84-96. [PMID: 27585029 PMCID: PMC5008134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND An opportunity to address the needs of patients with common mental disorders (CMDs) resides in primary care. Barriers are restricting availability of treatment for CMDs in primary care. By understanding the incentives that promote and the disincentives that deter treatment for CMDs in a collaborative primary care context, this study aims to help contribute to goals of greater access to mental healthcare. METHOD A qualitative pilot study using semi-structured interviews with thematic analysis. RESULTS Participants identified 10 themes of incentives and disincentives influencing quality treatment of CMDs in a collaborative primary care setting: high service demands, clinical presentation, patient-centred care, patient attributes, education, physician attributes, organizational, access to mental health resources, psychiatry and physician payment model. CONCLUSION An understanding of the incentives and disincentives influencing care is essential to achieve greater integration and capacity for care for the treatment of CMDs in primary care.
Collapse
Affiliation(s)
- Rachelle Ashcroft
- Assistant Professor, Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON
| | - Jose Silveira
- Chief of Psychiatry, Medical Director, Mental Health and Addiction Program, St. Joseph's Health Centre Assistant Professor, Department of Psychiatry, University of Toronto, Toronto, ON
| | - Kwame Mckenzie
- CEO of Wellesley Institute, Medical Director Health Equity, Centre for Addiction and Mental Health Professor, Department of Psychiatry, University of Toronto, Toronto, ON
| |
Collapse
|
3
|
Hosking J, Gibson C. Impact of the single point of access referral system to reduce waiting times and improve clinical outcomes in an assistive technology service. J Med Eng Technol 2016; 40:265-9. [PMID: 27098983 DOI: 10.3109/03091902.2016.1167972] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The introduction of a single point referral system that prioritises clients depending on case complexity and overcomes the need for re-admittance to a waiting list via a review system has been shown to significantly reduce maximum waiting times for a Posture and Mobility (Special Seating) Service from 102.0 ± 24.33 weeks to 19.2 ± 8.57 weeks (p = 0.015). Using this service model linear regression revealed a statistically significant improvement in the performance outcome of prescribed seating solutions with shorter Episode of Care completion times (p = 0.023). In addition, the number of Episodes of Care completed per annum was significantly related to the Episode of Care completion time (p = 0.019). In conclusion, it is recommended that it may be advantageous to apply this service model to other assistive technology services in order to reduce waiting times and to improve clinical outcomes.
Collapse
Affiliation(s)
- Jonathan Hosking
- a Rehabilitation Engineering Unit, Posture and Mobility Centre, Cardiff and Vale University Health Board , Pontypridd , Wales , UK
| | - Colin Gibson
- a Rehabilitation Engineering Unit, Posture and Mobility Centre, Cardiff and Vale University Health Board , Pontypridd , Wales , UK
| |
Collapse
|
4
|
Pawson R, Greenhalgh J, Brennan C. Demand management for planned care: a realist synthesis. HEALTH SERVICES AND DELIVERY RESEARCH 2016. [DOI: 10.3310/hsdr04020] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BackgroundThe task of matching fluctuating demand with available capacity is one of the basic challenges in all large-scale service industries. It is a particularly pressing concern in modern health-care systems, as increasing demand (ageing populations, availability of new treatments, increased patient knowledge, etc.) meets stagnating supply (capacity and funding restrictions on staff and services, etc.). As a consequence, a very large portfolio of demand management strategies has developed based on quite different assumptions about the source of the problem and about the means of its resolution.MethodsThis report presents a substantial review of the effectiveness of main strategies designed to alleviate demand pressures in the area of planned care. The study commences with an overview of the key ideas about the genesis of demand and capacity problems for health services. Many different diagnoses were uncovered: fluctuating demand meeting stationary capacity; turf protection between different providers; social rather than clinical pressures on referral decisions; self-propelling diagnostic cascades; supplier-induced demand; demographic pressures on treatment; and the informed patient and demand inflation. We then conducted a review of the key ideas (programme theories) underlying interventions designed to address demand imbalance. We discovered that there was no close alignment between purported problems and advocated solutions. Demand management interventions take their starting point in seeking reforms at the levels of strategic decision-making, organisational re-engineering, procedural modifications and behavioural change. In mapping the ideas for reform, we also noted a tendency for programme theories to become ‘whole-system’ models; over time policy-makers have advocated the need for concerted action on all of these fronts.FindingsThe remainder and core of the report contains a realist synthesis of the empirical evidence on the effectiveness on a spanning subset of four major demand management interventions: referral management centres (RMCs); using general practitioners with special interests (GPwSIs) at the interface between primary and secondary care; general practitioner (GP) direct access to clinical tests; and referral guidelines. In all cases we encountered a chequered pattern of success and failure. The primary literature is replete with accounts of unanticipated problems and unintended effects. These programmes ‘work’ only in highly circumscribed conditions. To give brief examples, we found that the success of RMCs depends crucially on the balance of control in their governance structures; GPwSIs influence demand only after close negotiations on an agreed and intermediate case mix; significant efficiencies are created by direct GP access to tests mainly when there is low diagnostic yield and high ‘rule-out’ rates; and referral guidelines are more likely to work when implemented by staff with responsibility for their creation.ConclusionsThe report concludes that there is no ‘preferred intervention’ that has the capacity to outperform all others. Instead, the review found many, diverse, hard-won, local and adaptive solutions. Whatever the starting point, success in demand management depends on synchronising a complex array of strategic, organisational, procedural and motivational changes. The final chapter offers practitioners some guidance on how they might ‘think through’ all of the interdependencies, which bring demand and capacity into equilibrium. A close analysis of the implementation of different configurations of demand management interventions in different local contexts using mixed methods would be valuable to understand the processes through which such interventions are tailored to local circumstances. There is also scope for further evidence synthesis. The substitution theory is ubiquitous in health and social care and a realist synthesis to compare the fortunes of different practitioners placed at different professional boundaries (e.g. nurses/doctors, dentists/dental care practitioners, radiologists/radiographers and so on) would be valuable to identify the contexts and mechanisms through which substitution, support or short-circuit occurs.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
Collapse
Affiliation(s)
- Ray Pawson
- School of Sociology and Social Policy, University of Leeds, Leeds, UK
| | - Joanne Greenhalgh
- School of Sociology and Social Policy, University of Leeds, Leeds, UK
| | - Cathy Brennan
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| |
Collapse
|
5
|
Fuller JD, Perkins D, Parker S, Holdsworth L, Kelly B, Roberts R, Martinez L, Fragar L. Building effective service linkages in primary mental health care: a narrative review part 2. BMC Health Serv Res 2011; 11:66. [PMID: 21435273 PMCID: PMC3070626 DOI: 10.1186/1472-6963-11-66] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2010] [Accepted: 03/25/2011] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Primary care services have not generally been effective in meeting mental health care needs. There is evidence that collaboration between primary care and specialist mental health services can improve clinical and organisational outcomes. It is not clear however what factors enable or hinder effective collaboration. The objective of this study was to examine the factors that enable effective collaboration between specialist mental health services and primary mental health care. METHODS A narrative and thematic review of English language papers published between 1998 and 2009. An expert reference group helped formulate strategies for policy makers. Studies of descriptive and qualitative design from Australia, New Zealand, UK, Europe, USA and Canada were included. Data were extracted on factors reported as enablers or barriers to development of service linkages. These were tabulated by theme at clinical and organisational levels and the inter-relationship between themes was explored. RESULTS A thematic analysis of 30 papers found the most frequently cited group of factors was "partnership formation", specifically role clarity between health care workers. Other factor groups supporting clinical partnership formation were staff support, clinician attributes, clinic physical features and evaluation and feedback. At the organisational level a supportive institutional environment of leadership and change management was important. The expert reference group then proposed strategies for collaboration that would be seen as important, acceptable and feasible. Because of the variability of study types we did not exclude on quality and findings are weighted by the number of studies. Variability in local service contexts limits the generalisation of findings. CONCLUSION The findings provide a framework for health planners to develop effective service linkages in primary mental health care. Our expert reference group proposed five areas of strategy for policy makers that address organisational level support, joint clinical problem solving, local joint care guidelines, staff training and supervision and feedback.
Collapse
Affiliation(s)
- Jeffrey D Fuller
- School of Nursing and Midwifery, Flinders University, Adelaide, Australia
- Northern Rivers University Department of Rural Health, School of Public Health, University of Sydney, Lismore, Australia
| | - David Perkins
- Broken Hill University Department of Rural Health, School of Public Health, University of Sydney, Broken Hill, Australia
| | | | - Louise Holdsworth
- Northern Rivers University Department of Rural Health, School of Public Health, University of Sydney, Lismore, Australia
- School of Tourism & Hospitality Management, Centre for Gambling Education & Research, Southern Cross University, Lismore, Australia
| | - Brian Kelly
- Faculty of Medicine, University of Newcastle, Newcastle, Australia
| | - Russell Roberts
- Greater Western Area Health Service, Orange, New South Wales, Australia
| | - Lee Martinez
- South Australian Department of Health, Adelaide, Australia
| | - Lyn Fragar
- Australian Centre for Agricultural Health and Safety, School of Public Health, Sydney University, Moree, Australia
| |
Collapse
|
8
|
Raine R, Cartwright M, Richens Y, Mahamed Z, Smith D. A qualitative study of women's experiences of communication in antenatal care: identifying areas for action. Matern Child Health J 2009; 14:590-9. [PMID: 19554436 DOI: 10.1007/s10995-009-0489-7] [Citation(s) in RCA: 40] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2009] [Accepted: 06/05/2009] [Indexed: 10/20/2022]
Abstract
To identify key features of communication across antenatal (prenatal) care that are evaluated positively or negatively by service users. Focus groups and semi-structured interviews were used to explore communication experiences of thirty pregnant women from diverse social and ethnic backgrounds affiliated to a large London hospital. Data were analysed using thematic analysis. Women reported a wide diversity of experiences. From the users' perspective, constructive communication on the part of health care providers was characterised by an empathic conversational style, openness to questions, allowing sufficient time to talk through any concerns, and pro-active contact by providers (e.g. text message appointment reminders). These features created reassurance, facilitated information exchange, improved appointment attendance and fostered tolerance in stressful situations. Salient features of poor communication were a lack of information provision, especially about the overall arrangement and the purpose of antenatal care, insufficient discussion about possible problems with the pregnancy and discourteous styles of interaction. Poor communication led some women to become assertive to address their needs; others became reluctant to actively engage with providers. General Practitioners need to be better integrated into antenatal care, more information should be provided about the pattern and purpose of the care women receive during pregnancy, and new technologies should be used to facilitate interactions between women and their healthcare providers. Providers require communications training to encourage empathic interactions that promote constructive provider-user relationships and encourage women to engage effectively and access the care they need.
Collapse
Affiliation(s)
- Rosalind Raine
- Health Care Evaluation Group, Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 6BT, UK.
| | | | | | | | | |
Collapse
|