PsyScan e-tool to support diagnosis and management of psychological problems in general practice: a randomised controlled trial

Abstract

Background: GPs are crucial in adequately diagnosing and initiating appropriate management for patients with psychological problems, but face many challenges and require support.

Aim: To determine the effects of the e-tool PsyScan.

Design and setting: A randomised controlled trial with a 1-year follow-up, comparing care using PsyScan with usual care for psychological problems, was undertaken in 10 multidisciplinary primary healthcare centres in Eindhoven, the Netherlands.

Method: Between consultations with their GP, participants in the intervention group could complete PsyScan. The e-tool consists of a distress screener and Four-Dimensional Symptom Questionnaire to differentiate between stress, depression, anxiety, and somatisation symptoms, and to explore symptom severity. PsyScan generated diagnostic and therapeutic advice for GPs and participants that was automatically transferred to each patient's electronic medical record. The primary outcome was the proportion of participants that achieved a successful treatment result; namely, a decrease of ≥50% on the Symptom Checklist-90-Revised, after 1 year.

Results: There were 176 participants in the intervention group and 160 in the control group. After multiple imputation, the participants in the intervention group had higher chances of achieving a successful treatment result compared with those in the control group (odds ratio [OR] 2.7, 95% confidence interval [CI] = 1.5 to 4.8, P = 0.002). Quality of life was higher in the intervention group at 12 months (mean difference in EuroQol 5 Dimensions 5 Levels index values was 0.076, 95% CI = 0.015 to 0.136, P = 0.01). The mean 1-year costs per participant were similar (€13 622 in intervention group, €12 487 in control group [β = -0.03, P = 0.71, R2 = 0.05]).

Conclusion: PsyScan generated clinically relevant and statistically significant effects, and could be useful in offering effective individualised care to patients.

Trial registration: ClinicalTrials.gov NCT01971307.

Keywords: general practice; mental health; patient portals; psychosocial support systems; randomised controlled trial.

© British Journal of General Practice 2018.

Figures

Figure 1.

Study flowchart. SCL-90-R = Symptom Checklist-90-Revised.

Figure 2.

Estimated means and 95% CIs based on linear mixed model analyses of SCL-90-R scores (n = 336). SCL-90-R = Symptom Checklist-90-Revised.