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Mental Health eConsults

30 ottobre 2019 aggiornato da: 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.

Panoramica dello studio

Stato

Completato

Condizioni

Intervento / Trattamento

Descrizione dettagliata

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.

Tipo di studio

Interventistico

Iscrizione (Anticipato)

900000

Fase

  • Non applicabile

Contatti e Sedi

Questa sezione fornisce i recapiti di coloro che conducono lo studio e informazioni su dove viene condotto lo studio.

Luoghi di studio

  • Stati Uniti
    • Minnesota
      • Minneapolis, Minnesota, Stati Uniti, 55407
        • Allina Health

Criteri di partecipazione

I ricercatori cercano persone che corrispondano a una certa descrizione, chiamata criteri di ammissibilità. Alcuni esempi di questi criteri sono le condizioni generali di salute di una persona o trattamenti precedenti.

Criteri di ammissibilità

Età idonea allo studio

  • Bambino
  • Adulto
  • Adulto più anziano

Accetta volontari sani

Sì

Sessi ammissibili allo studio

Tutto

Descrizione

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.

Piano di studio

Questa sezione fornisce i dettagli del piano di studio, compreso il modo in cui lo studio è progettato e ciò che lo studio sta misurando.

Come è strutturato lo studio?

Dettagli di progettazione

  • Scopo principale: Ricerca sui servizi sanitari
  • Assegnazione: Randomizzato
  • Modello interventistico: Assegnazione parallela
  • Mascheramento: Nessuno (etichetta aperta)

Armi e interventi

Gruppo di partecipanti / Arm
Intervento / Trattamento
Sperimentale: Mental Health eConsults
Primary care clinics that will receive the eConsults intervention at the start of the study.
Altro: 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.
Comparatore attivo: 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.
Altro: Care as usual
Providers in primary care clinics will deliver care as usual to their patients.

Cosa sta misurando lo studio?

Misure di risultato primarie

Misura del risultato
Misura Descrizione
Lasso di tempo
Use of eConsults
Lasso di tempo: 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

Misure di risultato secondarie

Misura del risultato
Misura Descrizione
Lasso di tempo
Frequency of specialist consultation
Lasso di tempo: 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
Lasso di tempo: 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
Lasso di tempo: 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
Lasso di tempo: 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
Lasso di tempo: 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
Lasso di tempo: 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
Lasso di tempo: 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
Lasso di tempo: 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
Lasso di tempo: 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
Lasso di tempo: 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
Lasso di tempo: 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
Lasso di tempo: 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
Lasso di tempo: 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
Lasso di tempo: 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
Lasso di tempo: 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

Altre misure di risultato

Misura del risultato
Misura Descrizione
Lasso di tempo
Emergency department use, 1 month
Lasso di tempo: 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
Lasso di tempo: 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
Lasso di tempo: 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
Lasso di tempo: 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
Lasso di tempo: 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
Lasso di tempo: 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
Lasso di tempo: 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
Lasso di tempo: 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

Collaboratori e investigatori

Qui è dove troverai le persone e le organizzazioni coinvolte in questo studio.

Sponsor

University of Minnesota

Collaboratori

Allina Health System

Investigatori

  • Investigatore principale: Ezra Golberstein, Ph.D., University of Minnesota

Studiare le date dei record

Queste date tengono traccia dell'avanzamento della registrazione dello studio e dell'invio dei risultati di sintesi a ClinicalTrials.gov. I record degli studi e i risultati riportati vengono esaminati dalla National Library of Medicine (NLM) per assicurarsi che soddisfino specifici standard di controllo della qualità prima di essere pubblicati sul sito Web pubblico.

Studia le date principali

Inizio studio

1 agosto 2015

Completamento primario (Effettivo)

1 gennaio 2017

Completamento dello studio (Effettivo)

1 marzo 2017

Date di iscrizione allo studio

Primo inviato

14 agosto 2015

Primo inviato che soddisfa i criteri di controllo qualità

18 agosto 2015

Primo Inserito (Stima)

19 agosto 2015

Aggiornamenti dei record di studio

Ultimo aggiornamento pubblicato (Effettivo)

1 novembre 2019

Ultimo aggiornamento inviato che soddisfa i criteri QC

30 ottobre 2019

Ultimo verificato

1 ottobre 2019

Maggiori informazioni

Termini relativi a questo studio

Termini MeSH pertinenti aggiuntivi

Altri numeri di identificazione dello studio

  • 1507S76668

Queste informazioni sono state recuperate direttamente dal sito web clinicaltrials.gov senza alcuna modifica. In caso di richieste di modifica, rimozione o aggiornamento dei dettagli dello studio, contattare register@clinicaltrials.gov. Non appena verrà implementata una modifica su clinicaltrials.gov, questa verrà aggiornata automaticamente anche sul nostro sito web .

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