Evaluation of a Collaborative Mental Health Care System
- Conditions
- Psychiatric Adults Patients
- Interventions
- Other: Clinical assessment by emergency psychiatristOther: Psychiatric consultation booked through Med@Psy platform
- Registration Number
- NCT06581874
- Lead Sponsor
- Centre Hospitalier Intercommunal de Toulon La Seyne sur Mer
- Brief Summary
In the absence of easy access to second-line ambulatory care, the number of 'inappropriate' psychiatric emergency visits is increasing, with emergency departments becoming the gateway to mental health care.
This is the context in which the 'med@psy' system was set up in the Toulon-Provence-Mediterranean metropolitan area by a private psychiatrist. It facilitates access to psychiatric second referral for General Practitioners (GPs) by pooling the 48-hour supply of psychiatric consultations in real time. It is assumed that this system will facilitate access to outpatient psychiatric care and help to optimize the organisation of patient care and follow-up. The aim of this study is to evaluate the med@psy system in the care pathway for patients with psychiatric disorders.
This study main objective is to compare the proportion of patients with a psychiatric disorder who will receive outpatient follow-up 1 month after a visit to a psychiatric emergency department without hospitalization (Group 1) versus 1 month after a consultation with a psychiatrist within 48 hours via the med@psy system (Group 2).
- Detailed Description
General practitioners (GPs) are the gateway to the healthcare system and therefore the first point of contact for mental health. A significant proportion of psychiatric disorders can be treated in primary care if GPs have easy access to psychiatric support. However, they are faced with difficulties in accessing secondary care. Around 9/10 consider that it is more difficult to obtain specialist advice than for other disciplines, and say they have difficulty referring a patient for mental health care.
In the absence of easy access to second-line ambulatory care, the number of 'inappropriate' psychiatric emergency visits is increasing, with emergency departments becoming the gateway to mental health care. It is recognized that the deployment of earlier and more graduated care reduces the intensity of disorders, prescriptions for time off work and psychotropic drugs, and hospitalizations.
A new, more preventive, efficient and cost-effective approach to mental health is emerging, with psychiatrists working closely with GPs. This is the context in which the 'med@psy' system was set up in the Toulon-Provence-Mediterranean metropolitan area by a private psychiatrist. It facilitates access to psychiatric second referral for GPs by pooling the 48-hour supply of psychiatric consultations in real time. We assume that this system will facilitate access to outpatient psychiatric care and help to optimize the organisation of patient care and follow-up. The aim of this study is to evaluate the med@psy system in the care pathway for patients with psychiatric disorders.
This study main objective is to compare the proportion of patients with a psychiatric disorder who will received outpatient follow-up 1 month after a visit to a psychiatric emergency department without hospitalization (Group 1) versus 1 month after a consultation with a psychiatrist within 48 hours via the med@psy system (Group 2).
Recruitment & Eligibility
- Status
- RECRUITING
- Sex
- All
- Target Recruitment
- 478
- Patient ≥ 18 years ;
- Patient presenting to the Centre hospitalier de Toulon La Seyne sur Mer emergency department, with or without referral, and receiving psychiatric advice with discharge without hospitaliszation after clinical assessment (Group 1) or patients referred for psychiatric consultation via the Med@psy system (Group 2).
- Patient with indication for outpatient follow-up
- Patient with open social security rights
- Patient's refusal to take part in research ;
- Patient currently being followed by a psychiatrist. Psychiatric follow-up is defined as at least one consultation with a psychiatrist in the last 3 months, outside an unscheduled care consultation or in an emergency department;
- Patients referred for a suicide attempt, violent or non-violent, serious or non-serious;
- Patients without a declared general practioner;
- Patients already included in the study;
- Patients who do not speak French;
- Patients under judicial protection (guardianship, curatorship, etc.) or safeguard of justice;
- Patient under compulsory care, under a care order or deprived of liberty.
- Any other reason which, in the investigator's opinion, could interfere
Study & Design
- Study Type
- INTERVENTIONAL
- Study Design
- PARALLEL
- Arm && Interventions
Group Intervention Description Emergency Clinical assessment by emergency psychiatrist Adult patients presenting to the emergency department of the Centre Hospitalier Intercommunal de Toulon La Seyne sur Mer, whether or not referred by their general practitioner. Med@Psy Platform Psychiatric consultation booked through Med@Psy platform Adult patients referred by their general practioner for a psychiatric consultation via the med@psy system.
- Primary Outcome Measures
Name Time Method Number of patients with a consultation with a psychiatrist, a psychologist or a general practioner one month after the consultation via the med@psy system or the visit to emergency department 1 month Setting up outpatient follow-up from a binary point of view (outpatient follow-up absent or present). This will be defined by whether or not each group has had at least one consultation with a psychiatrist (apart from emergency psychiatric consultations or psychiatric consultations set up at 48 hours with the system), a psychologist or a general practitioner.
It will be evaluated by means of a telephone survey carried out among patients 1 month after consultation with a psychiatrist via the med@psy system or a visit to the emergency department.
- Secondary Outcome Measures
Name Time Method Outpatient follow-up at three months 3 months Outpatient follow-up will be evaluated by the proportion of patients who have had at least one consultation with a psychiatrist, psychologist or general practitioner, in each group, by means of a telephone survey carried out with patients 3 months after the consultation or visit to the emergency department.
Medical partners commitment (part 1) 1 year Medical partners commitment will be assessed by the number of GPs and psychiatrists registered in the Med@psy program.
Medical partners commitment (part 2) 1 year Medical partners commitment will be assessed by the number of patients treated via the program.
Medical partners commitment (part 3) 1 year Medical partners commitment will be assessed by the frequency of use of Med@psy program.
Medical partners commitment (part 4) 1 year Medical partners commitment will be assessed by the average time between referral by the GPs and the psychiatric consultations offered through the Med@psy program, 12 months after its start of use.
Med@psy platform patients characteristics 1 month Description of the patient population who get a psychiatric consultation within 48 hours through the Med@psy platform but who don't come to the consultation. The elements which will be evaluated are : age, sex, place of residence, pathology and reason for referral by a GP.
Functioning Global Assessment 3 months Overall psychological, social and professional functioning will be assessed using the Global Assessment of Functioning (GAF), which will be carried out by a psychologist during a teleconsultation with the patient at 1 and 3 months. GAF is a scale used to rate how serious a mental illness may be. It measures how much a person's symptoms affect their day-to-day life on a scale of 0 to 100. 100 corresponds to a better ability to handle daily activities.
Trial Locations
- Locations (2)
Cabinet médical Korrichi (Med@psy program linked to this office)
🇫🇷Toulon, Var, France
Centre Hospitalier Intercommunal Toulon La Seyne sur Mer emergency reception service
🇫🇷Toulon, Var, France