Mental Health eConsults
30 de outubro de 2019 atualizado por: 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.
Visão geral do estudo
Status
Concluído
Condições
Intervenção / Tratamento
Descrição detalhada
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 de estudo
Intervencional
Inscrição (Antecipado)
900000
Estágio
- Não aplicável
Contactos e Locais
Esta seção fornece os detalhes de contato para aqueles que conduzem o estudo e informações sobre onde este estudo está sendo realizado.
Locais de estudo
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Minnesota
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Minneapolis, Minnesota, Estados Unidos, 55407
- Allina Health
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Critérios de participação
Os pesquisadores procuram pessoas que se encaixem em uma determinada descrição, chamada de critérios de elegibilidade. Alguns exemplos desses critérios são a condição geral de saúde de uma pessoa ou tratamentos anteriores.
Critérios de elegibilidade
Idades elegíveis para estudo
- Filho
- Adulto
- Adulto mais velho
Aceita Voluntários Saudáveis
Sim
Gêneros Elegíveis para o Estudo
Tudo
Descrição
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.
Plano de estudo
Esta seção fornece detalhes do plano de estudo, incluindo como o estudo é projetado e o que o estudo está medindo.
Como o estudo é projetado?
Detalhes do projeto
- Finalidade Principal: Pesquisa de serviços de saúde
- Alocação: Randomizado
- Modelo Intervencional: Atribuição Paralela
- Mascaramento: Nenhum (rótulo aberto)
Armas e Intervenções
Grupo de Participantes / Braço |
Intervenção / Tratamento |
|---|---|
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Experimental: 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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Comparador Ativo: 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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O que o estudo está medindo?
Medidas de resultados primários
Medida de resultado |
Descrição da medida |
Prazo |
|---|---|---|
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Use of eConsults
Prazo: 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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Medidas de resultados secundários
Medida de resultado |
Descrição da medida |
Prazo |
|---|---|---|
|
Frequency of specialist consultation
Prazo: 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
Prazo: 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
Prazo: 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
Prazo: 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
Prazo: 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
Prazo: 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
Prazo: 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
Prazo: 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
Prazo: 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
Prazo: 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
Prazo: 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
Prazo: 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
Prazo: 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
Prazo: 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
Prazo: 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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Outras medidas de resultado
Medida de resultado |
Descrição da medida |
Prazo |
|---|---|---|
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Emergency department use, 1 month
Prazo: 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
Prazo: 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
Prazo: 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
Prazo: 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
Prazo: 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
Prazo: 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.
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3-month
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Confidence in depression treatment
Prazo: 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
Prazo: 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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Colaboradores e Investigadores
É aqui que você encontrará pessoas e organizações envolvidas com este estudo.
Patrocinador
Colaboradores
Investigadores
- Investigador principal: Ezra Golberstein, Ph.D., University of Minnesota
Datas de registro do estudo
Essas datas acompanham o progresso do registro do estudo e os envios de resumo dos resultados para ClinicalTrials.gov. Os registros do estudo e os resultados relatados são revisados pela National Library of Medicine (NLM) para garantir que atendam aos padrões específicos de controle de qualidade antes de serem publicados no site público.
Datas Principais do Estudo
Início do estudo
1 de agosto de 2015
Conclusão Primária (Real)
1 de janeiro de 2017
Conclusão do estudo (Real)
1 de março de 2017
Datas de inscrição no estudo
Enviado pela primeira vez
14 de agosto de 2015
Enviado pela primeira vez que atendeu aos critérios de CQ
18 de agosto de 2015
Primeira postagem (Estimativa)
19 de agosto de 2015
Atualizações de registro de estudo
Última Atualização Postada (Real)
1 de novembro de 2019
Última atualização enviada que atendeu aos critérios de controle de qualidade
30 de outubro de 2019
Última verificação
1 de outubro de 2019
Mais Informações
Termos relacionados a este estudo
Termos MeSH relevantes adicionais
Outros números de identificação do estudo
- 1507S76668
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