Mental Health eConsults
30 octobre 2019 mis à jour par: 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.
Aperçu de l'étude
Statut
Complété
Les conditions
Intervention / Traitement
Description détaillée
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.
Type d'étude
Interventionnel
Inscription (Anticipé)
900000
Phase
- N'est pas applicable
Contacts et emplacements
Cette section fournit les coordonnées de ceux qui mènent l'étude et des informations sur le lieu où cette étude est menée.
Lieux d'étude
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Minnesota
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Minneapolis, Minnesota, États-Unis, 55407
- Allina Health
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Critères de participation
Les chercheurs recherchent des personnes qui correspondent à une certaine description, appelée critères d'éligibilité. Certains exemples de ces critères sont l'état de santé général d'une personne ou des traitements antérieurs.
Critère d'éligibilité
Âges éligibles pour étudier
- Enfant
- Adulte
- Adulte plus âgé
Accepte les volontaires sains
Oui
Sexes éligibles pour l'étude
Tout
La description
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.
Plan d'étude
Cette section fournit des détails sur le plan d'étude, y compris la façon dont l'étude est conçue et ce que l'étude mesure.
Comment l'étude est-elle conçue ?
Détails de conception
- Objectif principal: Recherche sur les services de santé
- Répartition: Randomisé
- Modèle interventionnel: Affectation parallèle
- Masquage: Aucun (étiquette ouverte)
Armes et Interventions
Groupe de participants / Bras |
Intervention / Traitement |
|---|---|
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Expérimental: Mental Health eConsults
Primary care clinics that will receive the eConsults intervention at the start of the study.
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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.
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Comparateur actif: 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.
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Providers in primary care clinics will deliver care as usual to their patients.
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Que mesure l'étude ?
Principaux critères de jugement
Mesure des résultats |
Description de la mesure |
Délai |
|---|---|---|
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Use of eConsults
Délai: Within one day of a primary care clinic visit
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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.
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Within one day of a primary care clinic visit
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Mesures de résultats secondaires
Mesure des résultats |
Description de la mesure |
Délai |
|---|---|---|
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Frequency of specialist consultation
Délai: Baseline and 6 months
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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.
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Baseline and 6 months
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How easy to consult with specialist
Délai: Baseline and 6 months
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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.
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Baseline and 6 months
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Patient contact with a specialist, 1 month
Délai: 1-month
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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.
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1-month
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Patient contact with a specialist, 3 months
Délai: 3-month
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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.
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3-month
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Patient contact with a specialist, 6 months
Délai: 6-month
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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.
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6-month
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Change in depression symptoms
Délai: Baseline office visit to followup within 6 months
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Depressive symptoms, as measured by the PHQ-9 at the office visit and again at a routine PHQ9 measurement within six months.
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Baseline office visit to followup within 6 months
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Total cost of care, 1 month
Délai: 1-month
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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.
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1-month
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Total cost of care, 3 month
Délai: 3-month
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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.
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3-month
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Total cost of care, 6 month
Délai: 6-month
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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.
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6-month
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Providers get needed support for mental health care
Délai: Baseline and 6 months
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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.
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Baseline and 6 months
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Any mental health service use, 2 week
Délai: 2-week
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Whether any mental health services (medication, counseling) were used after a primary care visit.
Data will be extracted from the electronic medical record system.
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2-week
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Any mental health service use, 1 month
Délai: 1-month
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Whether any mental health services (medication, counseling) were used after a primary care visit.
Data will be extracted from the electronic medical record system.
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1-month
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Any mental health service use, 3-month
Délai: 3-month
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Whether any mental health services (medication, counseling) were used after a primary care visit.
Data will be extracted from the electronic medical record system.
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3-month
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Any mental health service use, 6 month
Délai: 6-months
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Whether any mental health services (medication, counseling) were used after a primary care visit.
Data will be extracted from the electronic medical record system.
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6-months
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Provider-perceived patient access
Délai: Baseline and six months
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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.
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Baseline and six months
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Autres mesures de résultats
Mesure des résultats |
Description de la mesure |
Délai |
|---|---|---|
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Emergency department use, 1 month
Délai: 1-month
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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.
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1-month
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Emergency department use, 3 months
Délai: 3-month
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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.
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3-month
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Psychotropic medication use, 1 month
Délai: 1-month
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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.
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1-month
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Psychotropic medication use, 3 month
Délai: 3-month
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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.
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3-month
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Inpatient use, 1 month
Délai: 1-month
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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.
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1-month
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Inpatient use, 3 month
Délai: 3-month
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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.
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3-month
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Confidence in depression treatment
Délai: Baseline and six months
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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.
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Baseline and six months
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Skill in depression treatment
Délai: Baseline and six months
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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.
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Baseline and six months
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Collaborateurs et enquêteurs
C'est ici que vous trouverez les personnes et les organisations impliquées dans cette étude.
Parrainer
Collaborateurs
Les enquêteurs
- Chercheur principal: Ezra Golberstein, Ph.D., University of Minnesota
Dates d'enregistrement des études
Ces dates suivent la progression des dossiers d'étude et des soumissions de résultats sommaires à ClinicalTrials.gov. Les dossiers d'étude et les résultats rapportés sont examinés par la Bibliothèque nationale de médecine (NLM) pour s'assurer qu'ils répondent à des normes de contrôle de qualité spécifiques avant d'être publiés sur le site Web public.
Dates principales de l'étude
Début de l'étude
1 août 2015
Achèvement primaire (Réel)
1 janvier 2017
Achèvement de l'étude (Réel)
1 mars 2017
Dates d'inscription aux études
Première soumission
14 août 2015
Première soumission répondant aux critères de contrôle qualité
18 août 2015
Première publication (Estimation)
19 août 2015
Mises à jour des dossiers d'étude
Dernière mise à jour publiée (Réel)
1 novembre 2019
Dernière mise à jour soumise répondant aux critères de contrôle qualité
30 octobre 2019
Dernière vérification
1 octobre 2019
Plus d'information
Termes liés à cette étude
Termes MeSH pertinents supplémentaires
Autres numéros d'identification d'étude
- 1507S76668
Ces informations ont été extraites directement du site Web clinicaltrials.gov sans aucune modification. Si vous avez des demandes de modification, de suppression ou de mise à jour des détails de votre étude, veuillez contacter register@clinicaltrials.gov. Dès qu'un changement est mis en œuvre sur clinicaltrials.gov, il sera également mis à jour automatiquement sur notre site Web .