Computer-Aided Telephone Support for Primary Care Patients with Common Mental Health Conditions: Randomized Controlled Trial

Salaha Zaheer, Vanessa Garofalo, David Rodie, Athina Perivolaris, Jenny Chum, Allison Crawford, Rose Geist, Andrea Levinson, Brian Mitchell, David Oslin, Nadiya Sunderji, Benoit H Mulsant, PARTNERs Study Group, Salaha Zaheer, Vanessa Garofalo, David Rodie, Athina Perivolaris, Jenny Chum, Allison Crawford, Rose Geist, Andrea Levinson, Brian Mitchell, David Oslin, Nadiya Sunderji, Benoit H Mulsant, PARTNERs Study Group

Abstract

Background: Depression, anxiety, and at-risk drinking are highly prevalent in primary care settings. Many jurisdictions experience geographical barriers to accessing mental health services, necessitating the development and validation of alternative models of care delivery. Existing evidence supports the acceptability and effectiveness of providing mental health care by telephone.

Objective: This analysis assesses patient's acceptability of computer-aided telephone support delivered by lay providers to primary care patients with depression, anxiety, or at-risk drinking.

Methods: The Primary care Assessment and Research of a Telephone intervention for Neuropsychiatric conditions with Education and Resources study is a randomized controlled trial comparing a computer-aided telephone-based intervention to usual care enhanced by periodic assessments in adult primary care patients referred for the treatment of depression, anxiety, or at-risk drinking; no part of the study involves in-person contact. For this analysis, the following data were obtained: reasons provided for declining consent; reasons provided for withdrawing from the study; study retention rate; and a thematic analysis of a satisfaction survey upon study completion.

Results: During the consent process, 17.1% (114/667) patients referred to the study declined to participate and 57.0% of them (65/114) attributed their refusal to research-related factors (ie, randomization and time commitment); a further 16.7% (19/114) declined owing to the telephone delivery of the intervention. Among the 377 participants who were randomized to the 1-year intervention, the overall retention rate was 82.8% (312/377). Almost no participants who withdrew from the study identified the telephone components of the study as their reason for withdrawal. Analysis of a qualitative satisfaction survey revealed that 97% (38/39) of comments related to the telephone components were positive with key reported positive attributes being accessibility, convenience, and privacy.

Conclusions: Our results suggest that a computer-aided telephone support is highly acceptable to primary care patients with depression, anxiety, or at-risk drinking. In particular, these patients appreciate its accessibility, flexibility, and privacy.

Trial registration: ClinicalTrials.gov NCT02345122; https://ichgcp.net/clinical-trials-registry/NCT02345122 (Archived by WebCite at http://www.webcitation.org/73R9Q2cle).

Keywords: anxiety; at-risk drinking; collaborative care; depression; family medicine; general practice; lay provider; primary care psychiatry; telemedicine.

Conflict of interest statement

Conflicts of Interest: BM receives compensation from the following: the Department of Psychiatry, University of Toronto, Toronto, Ontario; CAMH, Toronto, Ontario; and the University of Pittsburgh, Pittsburgh, Pennsylvania. He belongs to the Board of Trustees of CAMH, Toronto, Ontario. He currently receives research support from Brain Canada, the Canadian Institutes of Health Research, the CAMH Foundation (funding of the study described in this paper with a gift from Bell Canada), the Patient-Centered Outcomes Research Institute, the US National Institute of Health (NIH), Capital Solution Design Limited Liability Corporation (software used in the study described in this paper), and HAPPYneuron (software used in a study founded by Brain Canada). Within the past 5 years, he has also received research support from Bristol-Myers Squibb (medications for a NIH–funded clinical trial), Eli-Lilly (medications for an NIH–funded clinical trial), and Pfizer (medications for an NIH–funded clinical trial). He directly owns stocks of General Electric (less than Can $5000).

©Salaha Zaheer, Vanessa Garofalo, David Rodie, Athina Perivolaris, Jenny Chum, Allison Crawford, Rose Geist, Andrea Levinson, Brian Mitchell, David Oslin, Nadiya Sunderji, Benoit H. Mulsant, PARTNERs Study Group. Originally published in JMIR Mental Health (http://mental.jmir.org), 10.12.2018.

Figures

Figure 1
Figure 1
Flow of participants (November 1, 2014 to April 30, 2017).
Figure 2
Figure 2
Distribution of responses to the question “overall, how would you rate the services you received?”(n=121).

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Source: PubMed

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