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Mental Health eConsults

30. oktober 2019 opdateret af: University of Minnesota

The Effects of Mental Health eConsults: A Clinic-level Randomized Trial

The purpose of this study is to assess whether electronic consultations between primary care providers and psychiatrists affects mental health services delivered in primary care settings.

Studieoversigt

Status

Afsluttet

Betingelser

Intervention / Behandling

Detaljeret beskrivelse

This study assesses the effects of electronic consultations (eConsults) between primary care providers and psychiatrists as a way to support the delivery of mental health services in primary care settings. The setting for the study are the primary care clinics of Allina Health.

The study uses a randomized rollout design. Across 45 primary care clinics, half of the clinics will be randomly assigned to receive access to eConsults at the start of the study. The other half of the clinics will provide care-as-usual for nine months, at which point they will also gain access to eConsults. Stratified randomization will be used, with stratification on whether primary care clinics have co-located specialty mental health services.

For primary care clinics that are given access to eConsults, the primary care providers in those clinics will have the option of ordering an eConsult on behalf of their patients, which will include specific questions about a particular patient's care. The request is routed to the service region's psychiatry pool, and the psychiatrists have the option of responding. If they choose to respond, the psychiatrist responds with their recommendations within one business day, and the PCP proceeds with care accordingly. The psychiatrist receives 0.75 work relative value units (wRVUs) for providing this service. All communications for the eConsult are routed through Allina's Epic system. Although patients will not be billed for eConsults over the course of the proposed research, some insurance plans do cover it and evidence of eConsult effectiveness may impel other insurers to cover the service.

The study will have two components. First, the investigators will collect web survey data from the primary care providers to assess how access to eConsults affects providers' perceptions of their support and skill for delivering mental health services to their patients. Second, the investigators will assess the effects of receiving eConsults at the patient level, by using data from the Electronic Medical Record system.

Undersøgelsestype

Interventionel

Tilmelding (Forventet)

900000

Fase

  • Ikke anvendelig

Kontakter og lokationer

Dette afsnit indeholder kontaktoplysninger for dem, der udfører undersøgelsen, og oplysninger om, hvor denne undersøgelse udføres.

Studiesteder

  • Forenede Stater
    • Minnesota
      • Minneapolis, Minnesota, Forenede Stater, 55407
        • Allina Health

Deltagelseskriterier

Forskere leder efter personer, der passer til en bestemt beskrivelse, kaldet berettigelseskriterier. Nogle eksempler på disse kriterier er en persons generelle helbredstilstand eller tidligere behandlinger.

Berettigelseskriterier

Aldre berettiget til at studere

  • Barn
  • Voksen
  • Ældre voksen

Tager imod sunde frivillige

Ja

Køn, der er berettiget til at studere

Alle

Beskrivelse

Inclusion Criteria:

  • For the provider surveys, we will recruit all of the primary care providers who work in Allina's primary care clinics to participate in the surveys
  • For the patient-level analysis, we will examine data from all patients seen in Allina's primary care clinics during the study period. We will include children and adults.

Exclusion Criteria:

  • We will exclude patients from the patient-level analysis who have opted that their secondary data not be used by Allina for research purposes.

Studieplan

Dette afsnit indeholder detaljer om studieplanen, herunder hvordan undersøgelsen er designet, og hvad undersøgelsen måler.

Hvordan er undersøgelsen tilrettelagt?

Design detaljer

  • Primært formål: Sundhedstjenesteforskning
  • Tildeling: Randomiseret
  • Interventionel model: Parallel tildeling
  • Maskning: Ingen (Åben etiket)

Våben og indgreb

Deltagergruppe / Arm
Intervention / Behandling
Eksperimentel: Mental Health eConsults
Primary care clinics that will receive the eConsults intervention at the start of the study.
Andet: Mental Health eConsults
Providers in primary care clinics who receive the intervention will be able to use electronic consultations (eConsults) with psychiatrists. If a primary care provider wishes to use eConsults, he/she will enter a specific question about a patient in the electronic medical record system and submit as an eConsult. A psychiatrist will review the question and the patient's record, and send a response back to the primary care provider within one business day.
Aktiv komparator: Usual care
Primary care clinics that will deliver care as usual for nine months, and will receive the eConsults intervention nine months subsequent to the eConsults "intervention" clinics.
Andet: Care as usual
Providers in primary care clinics will deliver care as usual to their patients.

Hvad måler undersøgelsen?

Primære resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
Use of eConsults
Tidsramme: Within one day of a primary care clinic visit
Whether an eConsult was actually ordered in a primary care visit for a mental health issue. Data will be extracted from the electronic medical record system.
Within one day of a primary care clinic visit

Sekundære resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
Frequency of specialist consultation
Tidsramme: Baseline and 6 months
Primary care providers report how often in the past 6 months they consult with a mental health specialist for help with a patient's mental health issues at the baseline web survey questionnaire and the 6-month followup survey. Survey data will be collected from up to 400 primary care providers.
Baseline and 6 months
How easy to consult with specialist
Tidsramme: Baseline and 6 months
Primary care providers report how easy it is in the past 6 months to consult with a mental health specialist for help with a patient's mental health issues at the baseline web survey questionnaire and the 6-month followup survey. Survey data will be collected from up to 400 primary care providers.
Baseline and 6 months
Patient contact with a specialist, 1 month
Tidsramme: 1-month
Whether patients see a mental health specialist within a month after a primary care visit. Data will be extracted from the electronic medical record system.
1-month
Patient contact with a specialist, 3 months
Tidsramme: 3-month
Whether patients see a mental health specialist within 3 months after a primary care visit. Data will be extracted from the electronic medical record system.
3-month
Patient contact with a specialist, 6 months
Tidsramme: 6-month
Whether patients see a mental health specialist within 6 months after a primary care visit. Data will be extracted from the electronic medical record system.
6-month
Change in depression symptoms
Tidsramme: Baseline office visit to followup within 6 months
Depressive symptoms, as measured by the PHQ-9 at the office visit and again at a routine PHQ9 measurement within six months.
Baseline office visit to followup within 6 months
Total cost of care, 1 month
Tidsramme: 1-month
Total health care spending one month after a primary care visit (including the primary care visit). Data will be extracted from the electronic medical record system.
1-month
Total cost of care, 3 month
Tidsramme: 3-month
Total health care spending three months after a primary care visit (including the primary care visit). Data will be extracted from the electronic medical record system.
3-month
Total cost of care, 6 month
Tidsramme: 6-month
Total health care spending six months after a primary care visit (including the primary care visit). Data will be extracted from the electronic medical record system.
6-month
Providers get needed support for mental health care
Tidsramme: Baseline and 6 months
Providers indicate agreement with whether they have adequate support for delivering five aspects of mental health care at the baseline web survey questionnaire and the 6-month followup survey. Survey data will be collected from up to 400 primary care providers.
Baseline and 6 months
Any mental health service use, 2 week
Tidsramme: 2-week
Whether any mental health services (medication, counseling) were used after a primary care visit. Data will be extracted from the electronic medical record system.
2-week
Any mental health service use, 1 month
Tidsramme: 1-month
Whether any mental health services (medication, counseling) were used after a primary care visit. Data will be extracted from the electronic medical record system.
1-month
Any mental health service use, 3-month
Tidsramme: 3-month
Whether any mental health services (medication, counseling) were used after a primary care visit. Data will be extracted from the electronic medical record system.
3-month
Any mental health service use, 6 month
Tidsramme: 6-months
Whether any mental health services (medication, counseling) were used after a primary care visit. Data will be extracted from the electronic medical record system.
6-months
Provider-perceived patient access
Tidsramme: Baseline and six months
Providers' perceptions of how quickly their patients are able to access needed specialty mental health services at the baseline web survey questionnaire and the 6-month followup survey. Survey data will be collected from up to 400 primary care providers.
Baseline and six months

Andre resultatmål

Resultatmål
Foranstaltningsbeskrivelse
Tidsramme
Emergency department use, 1 month
Tidsramme: 1-month
Whether there was any emergency department use in the months after a primary care visit. Data will be extracted from the electronic medical record system.
1-month
Emergency department use, 3 months
Tidsramme: 3-month
Whether there was any emergency department use in the three months after a primary care visit. Data will be extracted from the electronic medical record system.
3-month
Psychotropic medication use, 1 month
Tidsramme: 1-month
Whether there was any psychotropic drug prescription and use in the month after a primary care visit. Data will be extracted from the electronic medical record system.
1-month
Psychotropic medication use, 3 month
Tidsramme: 3-month
Whether there was any psychotropic drug prescription and use in the three months after a primary care visit. Data will be extracted from the electronic medical record system.
3-month
Inpatient use, 1 month
Tidsramme: 1-month
Whether there was any emergency department use in the month after a primary care visit. Data will be extracted from the electronic medical record system.
1-month
Inpatient use, 3 month
Tidsramme: 3-month
Whether there was any emergency department use in the three months after a primary care visit. Data will be extracted from the electronic medical record system.
3-month
Confidence in depression treatment
Tidsramme: Baseline and six months
Providers are asked about their levels of confidence in five aspects of depression treatment at the baseline web survey questionnaire and the 6-month followup survey. Survey data will be collected from up to 400 primary care providers.
Baseline and six months
Skill in depression treatment
Tidsramme: Baseline and six months
Providers are asked to assess their skill in four aspects of depression treatment at the baseline web survey questionnaire and the 6-month followup survey. Survey data will be collected from up to 400 primary care providers.
Baseline and six months

Samarbejdspartnere og efterforskere

Det er her, du vil finde personer og organisationer, der er involveret i denne undersøgelse.

Sponsor

University of Minnesota

Samarbejdspartnere

Allina Health System

Efterforskere

  • Ledende efterforsker: Ezra Golberstein, Ph.D., University of Minnesota

Datoer for undersøgelser

Disse datoer sporer fremskridtene for indsendelser af undersøgelsesrekord og resumeresultater til ClinicalTrials.gov. Studieregistreringer og rapporterede resultater gennemgås af National Library of Medicine (NLM) for at sikre, at de opfylder specifikke kvalitetskontrolstandarder, før de offentliggøres på den offentlige hjemmeside.

Studer store datoer

Studiestart

1. august 2015

Primær færdiggørelse (Faktiske)

1. januar 2017

Studieafslutning (Faktiske)

1. marts 2017

Datoer for studieregistrering

Først indsendt

14. august 2015

Først indsendt, der opfyldte QC-kriterier

18. august 2015

Først opslået (Skøn)

19. august 2015

Opdateringer af undersøgelsesjournaler

Sidste opdatering sendt (Faktiske)

1. november 2019

Sidste opdatering indsendt, der opfyldte kvalitetskontrolkriterier

30. oktober 2019

Sidst verificeret

1. oktober 2019

Mere information

Begreber relateret til denne undersøgelse

Yderligere relevante MeSH-vilkår

Andre undersøgelses-id-numre

  • 1507S76668

Disse oplysninger blev hentet direkte fra webstedet clinicaltrials.gov uden ændringer. Hvis du har nogen anmodninger om at ændre, fjerne eller opdatere dine undersøgelsesoplysninger, bedes du kontakte register@clinicaltrials.gov. Så snart en ændring er implementeret på clinicaltrials.gov, vil denne også blive opdateret automatisk på vores hjemmeside .

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Betingelser

Sjældne sygdomme

Narkotikainterventioner

Kosttilskud

Sponsor / samarbejdspartnere

Placeringer

Abonner