Diese Seite wurde automatisch übersetzt und die Genauigkeit der Übersetzung wird nicht garantiert. Bitte wende dich an die englische Version für einen Quelltext.

Mental Health eConsults

30. Oktober 2019 aktualisiert von: 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.

Studienübersicht

Status

Abgeschlossen

Bedingungen

Intervention / Behandlung

Detaillierte Beschreibung

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.

Studientyp

Interventionell

Einschreibung (Voraussichtlich)

900000

Phase

  • Unzutreffend

Kontakte und Standorte

Dieser Abschnitt enthält die Kontaktdaten derjenigen, die die Studie durchführen, und Informationen darüber, wo diese Studie durchgeführt wird.

Studienorte

  • Vereinigte Staaten
    • Minnesota
      • Minneapolis, Minnesota, Vereinigte Staaten, 55407
        • Allina Health

Teilnahmekriterien

Forscher suchen nach Personen, die einer bestimmten Beschreibung entsprechen, die als Auswahlkriterien bezeichnet werden. Einige Beispiele für diese Kriterien sind der allgemeine Gesundheitszustand einer Person oder frühere Behandlungen.

Zulassungskriterien

Studienberechtigtes Alter

  • Kind
  • Erwachsene
  • Älterer Erwachsener

Akzeptiert gesunde Freiwillige

Ja

Studienberechtigte Geschlechter

Alle

Beschreibung

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.

Studienplan

Dieser Abschnitt enthält Einzelheiten zum Studienplan, einschließlich des Studiendesigns und der Messung der Studieninhalte.

Wie ist die Studie aufgebaut?

Designdetails

  • Hauptzweck: Versorgungsforschung
  • Zuteilung: Zufällig
  • Interventionsmodell: Parallele Zuordnung
  • Maskierung: Keine (Offenes Etikett)

Waffen und Interventionen

Teilnehmergruppe / Arm
Intervention / Behandlung
Experimental: Mental Health eConsults
Primary care clinics that will receive the eConsults intervention at the start of the study.
Sonstiges: 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.
Aktiver 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.
Sonstiges: Care as usual
Providers in primary care clinics will deliver care as usual to their patients.

Was misst die Studie?

Primäre Ergebnismessungen

Ergebnis Maßnahme
Maßnahmenbeschreibung
Zeitfenster
Use of eConsults
Zeitfenster: 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

Sekundäre Ergebnismessungen

Ergebnis Maßnahme
Maßnahmenbeschreibung
Zeitfenster
Frequency of specialist consultation
Zeitfenster: 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
Zeitfenster: 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
Zeitfenster: 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
Zeitfenster: 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
Zeitfenster: 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
Zeitfenster: 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
Zeitfenster: 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
Zeitfenster: 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
Zeitfenster: 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
Zeitfenster: 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
Zeitfenster: 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
Zeitfenster: 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
Zeitfenster: 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
Zeitfenster: 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
Zeitfenster: 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

Andere Ergebnismessungen

Ergebnis Maßnahme
Maßnahmenbeschreibung
Zeitfenster
Emergency department use, 1 month
Zeitfenster: 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
Zeitfenster: 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
Zeitfenster: 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
Zeitfenster: 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
Zeitfenster: 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
Zeitfenster: 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
Zeitfenster: 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
Zeitfenster: 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

Mitarbeiter und Ermittler

Hier finden Sie Personen und Organisationen, die an dieser Studie beteiligt sind.

Sponsor

University of Minnesota

Mitarbeiter

Allina Health System

Ermittler

  • Hauptermittler: Ezra Golberstein, Ph.D., University of Minnesota

Studienaufzeichnungsdaten

Diese Daten verfolgen den Fortschritt der Übermittlung von Studienaufzeichnungen und zusammenfassenden Ergebnissen an ClinicalTrials.gov. Studienaufzeichnungen und gemeldete Ergebnisse werden von der National Library of Medicine (NLM) überprüft, um sicherzustellen, dass sie bestimmten Qualitätskontrollstandards entsprechen, bevor sie auf der öffentlichen Website veröffentlicht werden.

Haupttermine studieren

Studienbeginn

1. August 2015

Primärer Abschluss (Tatsächlich)

1. Januar 2017

Studienabschluss (Tatsächlich)

1. März 2017

Studienanmeldedaten

Zuerst eingereicht

14. August 2015

Zuerst eingereicht, das die QC-Kriterien erfüllt hat

18. August 2015

Zuerst gepostet (Schätzen)

19. August 2015

Studienaufzeichnungsaktualisierungen

Letztes Update gepostet (Tatsächlich)

1. November 2019

Letztes eingereichtes Update, das die QC-Kriterien erfüllt

30. Oktober 2019

Zuletzt verifiziert

1. Oktober 2019

Mehr Informationen

Begriffe im Zusammenhang mit dieser Studie

Zusätzliche relevante MeSH-Bedingungen

Andere Studien-ID-Nummern

  • 1507S76668

Diese Informationen wurden ohne Änderungen direkt von der Website clinicaltrials.gov abgerufen. Wenn Sie Ihre Studiendaten ändern, entfernen oder aktualisieren möchten, wenden Sie sich bitte an register@clinicaltrials.gov. Sobald eine Änderung auf clinicaltrials.gov implementiert wird, wird diese automatisch auch auf unserer Website aktualisiert .

Klinische Studien zur Psychische Störungen

Klinische Studien zur Mental Health eConsults

Suchen Sie nach ähnlichen Studien

Sponsoren und Mitarbeiter

Krankheiten

Drogeninterventionen

CROs by country

CROs in Ecuador

Bedingungen

Seltene Krankheiten

Drogeninterventionen

Nahrungsergänzungsmittel

Sponsor / Mitarbeiter

Standorte

Abonnieren