Improving Access to Psychiatric Care and the Fluidity of Care Pathways for Patients Suffering From Mental Disorders in Primary Care in France: Evaluation of a Psychiatric Consultation-liaison System
Trial Snapshot
- Phase
- Not Applicable
- Status
- Terminated
- Enrollment
- 151
- Locations
- 1
- Primary Endpoint
- Number of patients who had access to a consultation with a psychiatrist
Study Overview
Brief Summary
Getting a consultation with a psychiatrist within an appropriate time is one of the main issues reported by general practitioners (GP) for patients suffering from mental disorders in primary care. Consultation liaison in psychiatry is a system focused on general medicine-psychiatry collaboration. The aim of the present study is to evaluate the impact of the consultation-liaison on the adequacy of the access time to a psychiatric consultation according to the degree of urgency evaluated by the GP.
Detailed Description
Faced with the saturation of the psychiatric care system, who recognizes the key role of the GP in mental health. Three-quarters of prescriptions for antidepressants and anxiolytics are performed by GPs, but less than one in four people with depression have been diagnosed and treated appropriately. The GPs describe difficulties in accessing psychiatric professionals and in particular to obtain a quick consultation with a psychiatrist. In different countries, psychiatric consultation-liaison (CL), centered on the collaboration of general medicine and psychiatry, have emerged. Two meta-analyzes and a Cochrane review were conducted on CL but no clinical trials were conducted in France. CL seems to improve patients' health at 3 months as well as their satisfaction and adherence to care. Results regarding the improvement of prescriptions from GP are encouraging. Better clinical trials are being requested and a need for medico-economic studies is also identified.
In France, a psychiatry CL was born in Toulouse in 2017, the "DSPP". The present study plans a 2 groups randomized clinical trial, one group of GPs having access to DSPP, the other not. For a period of 3 months, the GPs propose to any patient, for whom they want a psychiatric consultation, to participate in the study and address him/her to a psychiatrist. The DSPP is an evaluation center without long-term patient follow-up. Only patient referred by his/her GP can get into the DSPP.
Study Design
- Study Type
- Interventional
- Allocation
- Randomized
- Intervention Model
- Parallel
- Primary Purpose
- Supportive Care
- Masking
- Single (Outcomes Assessor)
Eligibility Criteria
- Ages
- 15 Years to — (Child, Adult, Older Adult)
- Sex
- All
- Accepts Healthy Volunteers
- No
Inclusion Criteria
- •15 years patient or older:
- •presenting mental suffering or a frequent or severe mental disorder
- •having consulted his GP who ask for psychiatric consultation
- •having given its consent for the use of its medico-administrative data
- •affiliated with the general health insurance scheme
- •of which the GP is from Haute Garonne and is voluntary to participate in the study
- •Free, informed and written consent signed by the participant and the investigator (at the latest on the day of inclusion and before any examination required by the research) and by one of the parents for minor participants
Exclusion Criteria
- •Patient with ongoing psychiatric follow-up
- •Patient unable to answer questionnaires (unable to read or write)
- •Patients receiving a measure of legal protection
Arms & Interventions
Shared care device in psychiatry (DSPP)
System focused on collaboration between general medicine (GP) and psychiatry, offering psychiatric assessment consultations and guidance for patient addressed by his/her GP. Referrals are made to the GP with support for care or the patient can be oriented to routine psychiatric care.
Intervention: Shared care device in psychiatry (DSPP) (Other)
Care as usual
Patient will have usual care :
Psychiatric care available in the Haute Garonne: psychiatric consultation by a liberal psychiatrist or by a psychiatrist working in public health center
Intervention: Usual Care (Other)
Outcomes
Primary Outcomes
Number of patients who had access to a consultation with a psychiatrist
Time Frame: 2 to 21 working days after inclusion
Number of patients who had access to a consultation with a psychiatrist within 2 working days following the GP consultation for patients whose GP wishes an "urgent" consultation, within 7 working days for a "quick" consultation and within 21 working days for a "non-urgent" consultation.
Secondary Outcomes
- Number of passages to psychiatric emergencies(6 months)
- Number of suicide attempts(6 months)
- Duration of prescription of different drugs(date of inclusion, 1 month and 6 months after inclusion)
- Evaluation of compliance with antidepressant prescriptions(date of inclusion, 1 month and 6 months after inclusion)
- Mental health status by Patient Health Questionnaire (PHQ)(date of inclusion, 1 month and 6 months after inclusion)
- Number of days between M0 (GP consultation) and M1 (psychiatric consultation)(6 months)
- Employment status(6 months)
- Patient satisfaction(1 month)
- Quality of life with EuroQol scale(6 months)
- Cost-Effectiveness Ratios of Patient Management Strategies(6 months)
- Mental health status by Symptom Checklist (SCL)(date of inclusion, 1 month and 6 months after inclusion)
- Number of prescription treatment of mental disorders(date of inclusion, 1 month and 6 months after inclusion)
- Incremental Cost-Utility(6 months)
- GP satisfaction(6 months)
- Production costs(6 months)