Mental Health Specialist Video Consultations for Primary Care Patients
- Conditions
- DepressionAnxiety Disorder
- Interventions
- Behavioral: mental health specialist video consultation
- Registration Number
- NCT04316572
- Lead Sponsor
- Heidelberg University
- Brief Summary
Even in Western health care systems, most people with mental disorders, including those with severe and chronic disorders, are treated solely by their general practitioner (GP). Notably, the accessibility of mental health specialist care is mainly complicated by (a) long waiting times for specialists, (b) long travel distances to specialists, particularly in rural and remote areas, (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 measure the effectiveness of a mental health specialist video consultations model versus treatment as usual in patients with depression or anxiety disorders in primary care. In an individually randomized, prospective, two-arm superiority study with parallel group design, N = 320 patients with anxiety and/or depressive disorder will be recruited in GP practices.
- Detailed Description
The purpose of this study is to measure the effectiveness of a mental health specialist video consultations model versus treatment as usual in patients with depression or anxiety disorders in primary care. In total, the investigators plan to enrol 320 patients who will be randomly allocated to the experimental condition (mental health specialist video consultations) or the control condition (treatment as usual from their GP) in a 1:1 ratio. General practitioners will recruit patients during their regular clinic hours. If the patient is interested in participation, the patient will receive the informed consent form and the baseline questionnaire from the GP. The practice team will send the patient's contact details to the study team who will screen the patient with respect to the eligibility criteria.
Patients will be randomly allocated to one of the two study conditions (video consultation model vs. treatment-as-usual, TAU) in a 1:1 ratio by central randomisation.
The evaluation of the primary outcome will be performed according to the intention-to-treat principle.
The health economic evaluation will be carried out from the perspective of society. A cost-effectiveness and a cost-utility analysis will be carried out.
Recruitment & Eligibility
- Status
- COMPLETED
- Sex
- All
- Target Recruitment
- 376
- at least one of the following psychological conditions i) at least moderately severe depression, defined as a PHQ-9 score of 10 or greater with either item one and/or two being endorsed, ii) at least moderately general anxiety disorder, defined as a Generalized Anxiety Disorder (GAD)-7 score of 10 or greater, or iii) exceeding the cut off of 11 points of the combined anxiety and depression score (PHQ-ADS)
- currently no or as yet insufficient treatment (psychotherapy, psychopharmacotherapy, or both) or difficulty with adherence
- capable of giving consent
- written informed consent
- substance abuse/dependence that is likely to compromise intervention adherence
- risk of endangerment to others and/or risk of self-endangerment
- need for emergency medical treatment
- acute psychotic symptoms
- severe cognitive impairment or dementia
- significant hearing and/or visual impairment
- pregnancy in the ≥ 2nd Trimester
- prior experience with video consultations as part of the feasibility trial
- insufficient German language proficiency
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description mental health specialist video consultation mental health specialist video consultation The intervention group will receive five video consultations with psychotherapists directly in the GP's practice. The consultations will be carried out via the web portal of a certified video service provider (arztkonsultation ak GmbH). The patient will be located in the GP's practice and the psychotherapist in his practice or another suitable room. Patients are scheduled for five sessions of 50 minutes.
- Primary Outcome Measures
Name Time Method The Patient Health Questionnaire Depression and Anxiety Scale (PHQ-ADS) 6 months after inclusion composite measure of depression and anxiety (range: 0-48 Points, higher score indicates more severly depressed/anxious)
- Secondary Outcome Measures
Name Time Method Short-Form Health Survey 12 (SF-12) 6 months after inclusion, 12 months after inclusion health related quality of life (two dimensions: physical and mental quality of life, ranges: 0-100, higher score indicates higher quality of life
The Patient Health Questionnaire (PHQ-9) 6 months after inclusion, 12 months after inclusion depressive symptom severity (range: 0-27 Points, higher score indicates more severly depressed)
Generalized Anxiety Disorder Scale (GAD-7) 6 months after inclusion, 12 months after inclusion anxiety symptom severity, range: 0-21, higher score indicates worse outcome
Patient Assessment of Chronic Illness Care (PACIC) 6 months after inclusion, 12 months after inclusion patients' satisfaction with the care of their chronic disease, range: 1-5, higher score indicates higher satisfaction
Questionnaire for the Assessment of Medical and non Medical Resource Utilisation in Mental Disorders (FIMPsy) 6 months after inclusion, 12 months after inclusion self reported use of medical and psychosocial services for health-economic evaluation
The Patient Health Questionnaire Depression and Anxiety Scale (PHQ-ADS) 12 months after inclusion composite measure of depression and anxiety (range: 0-48 Points, higher score indicates more severly depressed/anxious)
Recovery Assessment Scale (RAS-G) 6 months after inclusion, 12 months after inclusion self-reported mental health recovery, five dimension: 1) Goal and success orientation, 2) No domination by Symptoms, 3) Personal confidence and hope, 4) Reliance on others, 5) Willingness to ask others for help, ranges 1-5, higher score indicates better outcome
Somatic Symptom Disorder-B Criteria Scale (SSD-12) 6 months after inclusion, 12 months after inclusion self-reported somatisation, range: 0-48, higher score indicates worse outcome
EQ-5D 6 months after inclusion, 12 months after inclusion health related quality of life for health economic Evaluations, 5 dimensions: 1) Mobility, 2) Self-Care, 3) Usual Activities, 4) Pain/Discomfort, 5)Anxiety/Depression
Trial Locations
- Locations (1)
Heidelberg University
🇩🇪Heidelberg, Baden-Wuerttemberg, Germany