scholarly journals Potential for Integrating Mental Health Specialist Video Consultations in Office-Based Routine Primary Care: Cross-Sectional Qualitative Study Among Family Physicians

10.2196/13382 ◽  
2019 ◽  
Vol 21 (8) ◽  
pp. e13382 ◽  
Author(s):  
Mariell Hoffmann ◽  
Mechthild Hartmann ◽  
Michel Wensing ◽  
Hans-Christoph Friederich ◽  
Markus W Haun
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Qualitative Study ◽  
Primary Care Practice ◽  
Family Physicians ◽  
Health Conditions ◽  
Care Practice ◽  
Cross Sectional ◽  
Mental Health Specialist ◽  
Health Specialist

Background Although real-time mental health specialist video consultations have been proposed as an effective care model for treating patients with mental health conditions in primary care, little is known about their integration into routine practice from the perspective of family physicians. Objective This study aimed to determine the degree to which family physicians advocate that mental health specialist video consultations can be integrated into routine primary care, where most patients with mental health conditions receive treatment. Methods In a cross-sectional qualitative study, we conducted 4 semistructured focus groups and 3 telephonic interviews in a sample of 19 family physicians from urban and rural districts. We conducted a qualitative content analysis applying the Tailored Implementation in Chronic Diseases framework in a combined bottom-up (data-driven) and top-down strategy for deriving key domains. Results Family physicians indicated that mental health specialist video consultations are a promising and practical way to address the most pressing challenges in current practice, that is, to increase the accessibility and co-ordination of specialized care. Individual health professional factors were the most frequently discussed topics. Specifically, family physicians valued the anticipated clinical outcomes for patients and the anticipated resources set for the primary care practice as major facilitators (16/19, 84%). However, family physicians raised a concern regarding a lack of facial expressions and physical interaction (19/19, 100%), especially in emergency situations. Therefore, most family physicians considered a viable emergency plan for mental health specialist video consultations that clearly delineates the responsibilities and tasks of both family physicians and mental health specialists to be essential (11/19, 58%). Social, political, and legal factors, as well as guideline factors, were hardly discussed as prerequisites for individual family physicians to integrate mental health specialist video consultations into routine care. To facilitate the implementation of future mental health specialist video consultation models, we compiled a checklist of recommendations that covers (1) buy-in from practices (eg, emphasizing logistical and psychological relief for the practice), (2) the engagement of patients (eg, establishing a trusted patient-provider relationship), (3) the setup and conduct of consultations (eg, reliable emergency plans), and (4) the fostering of collaboration between family physicians and mental health specialists (eg, kick-off meetings to build trust). Conclusions By leveraging the primary care practice as a familiar environment for patients, mental health specialist video consultations provide timely specialist support and potentially lead to benefits for patients and more efficient processes of care. Integration should account for the determinants of practice as described by the family physicians. Trial Registration German Clinical Trials Register DRKS00012487; https://www.drks.de/drks_web/navigate.do? navigationId=trial.HTML&TRIAL_ID=DRKS00012487

scholarly journals Potential for Integrating Mental Health Specialist Video Consultations in Office-Based Routine Primary Care: Cross-Sectional Qualitative Study Among Family Physicians (Preprint)

2019 ◽  
Author(s):  
Mariell Hoffmann ◽  
Mechthild Hartmann ◽  
Michel Wensing ◽  
Hans-Christoph Friederich ◽  
Markus W Haun
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Qualitative Study ◽  
Primary Care Practice ◽  
Family Physicians ◽  
Health Conditions ◽  
Care Practice ◽  
Cross Sectional ◽  
Mental Health Specialist ◽  
Health Specialist

BACKGROUND Although real-time mental health specialist video consultations have been proposed as an effective care model for treating patients with mental health conditions in primary care, little is known about their integration into routine practice from the perspective of family physicians. OBJECTIVE This study aimed to determine the degree to which family physicians advocate that mental health specialist video consultations can be integrated into routine primary care, where most patients with mental health conditions receive treatment. METHODS In a cross-sectional qualitative study, we conducted 4 semistructured focus groups and 3 telephonic interviews in a sample of 19 family physicians from urban and rural districts. We conducted a qualitative content analysis applying the Tailored Implementation in Chronic Diseases framework in a combined bottom-up (data-driven) and top-down strategy for deriving key domains. RESULTS Family physicians indicated that mental health specialist video consultations are a promising and practical way to address the most pressing challenges in current practice, that is, to increase the accessibility and co-ordination of specialized care. Individual health professional factors were the most frequently discussed topics. Specifically, family physicians valued the anticipated clinical outcomes for patients and the anticipated resources set for the primary care practice as major facilitators (16/19, 84%). However, family physicians raised a concern regarding a lack of facial expressions and physical interaction (19/19, 100%), especially in emergency situations. Therefore, most family physicians considered a viable emergency plan for mental health specialist video consultations that clearly delineates the responsibilities and tasks of both family physicians and mental health specialists to be essential (11/19, 58%). Social, political, and legal factors, as well as guideline factors, were hardly discussed as prerequisites for individual family physicians to integrate mental health specialist video consultations into routine care. To facilitate the implementation of future mental health specialist video consultation models, we compiled a checklist of recommendations that covers (1) buy-in from practices (eg, emphasizing logistical and psychological relief for the practice), (2) the engagement of patients (eg, establishing a trusted patient-provider relationship), (3) the setup and conduct of consultations (eg, reliable emergency plans), and (4) the fostering of collaboration between family physicians and mental health specialists (eg, kick-off meetings to build trust). CONCLUSIONS By leveraging the primary care practice as a familiar environment for patients, mental health specialist video consultations provide timely specialist support and potentially lead to benefits for patients and more efficient processes of care. Integration should account for the determinants of practice as described by the family physicians. CLINICALTRIAL German Clinical Trials Register DRKS00012487; https://www.drks.de/drks_web/navigate.do? navigationId=trial.HTML&TRIAL_ID=DRKS00012487

scholarly journals Patients’ Perspective on Mental Health Specialist Video Consultations in Primary Care: Qualitative Preimplementation Study of Anticipated Benefits and Barriers

10.2196/17330 ◽  
2020 ◽  
Vol 22 (4) ◽  
pp. e17330 ◽  
Author(s):  
Caroline Bleyel ◽  
Mariell Hoffmann ◽  
Michel Wensing ◽  
Mechthild Hartmann ◽  
Hans-Christoph Friederich ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Psychosocial Care ◽  
Care Practice ◽  
Service Users ◽  
Mental Health Specialist ◽  
Face To Face ◽  
Specialist Services ◽  
Health Specialist ◽  
Patients Perspective

Background Due to limited access to specialist services, most patients with common mental disorders (depression or anxiety, or both) usually receive treatment in primary care. More recently, innovative technology-based care models (eg, video consultations) have been proposed to facilitate access to specialist services. Against this background, the PROVIDE (Improving Cross-Sectoral Collaboration Between Primary and Psychosocial Care: An Implementation Study on Video Consultations) project aims to improve the provision of psychosocial care through implementing video consultations integrated into routine primary care. Objective From the patients’ perspective, this qualitative preimplementation study explored (1) anticipated benefits from and (2) barriers to implementing mental health specialist video consultations embedded in primary care services and (3) prerequisites for interacting with therapists via video consultations. Methods Using a purposive (ie, stratified) sampling strategy, we recruited 13 patients from primary care practices and a tertiary care hospital (psychosomatic outpatient clinic) for one-off semistructured interviews. In a computer-assisted thematic analysis, we inductively (bottom-up) derived key themes concerning the practicability of mental health specialist video consultations. To validate our results, we discussed our findings with the interviewees as part of a systematic member checking. Results Overall, we derived 3 key themes and 10 subthemes. Participants identified specific benefits in 2 areas: the accessibility of mental health specialist care (shorter waiting times: 11/13, 85%; lower threshold for seeking specialist mental health care: 6/13, 46%; shorter travel distances: 3/13, 23%); and the environment in primary care (familiar travel modalities, premises, and employees: 5/13, 38%). The main barriers to the implementation of mental health video consultations from the patients’ perspective were the lack of face-to-face contact (13/13, 100%) and technical challenges (12/13, 92%). Notably, participants’ prerequisites for interacting with therapists (12/13, 92%) did not seem to differ much from those concerning face-to-face contacts. Conclusions Mental health service users mostly welcomed mental health specialist video consultations in primary care. Taking a pragmatic stance, service users, who are often frustrated about uncoordinated care, particularly valued the embedment of the consultations in the familiar environment of the primary care practice. With respect to interventional studies and implementation, our findings underscore the need to minimize technical disruptions during video consultations and to ensure optimal resemblance to face-to-face settings (eg, by training therapists in consistently reacting to nonverbal cues). Trial Registration German Clinical Trials Register DRKS00012487; https://tinyurl.com/uhg2one

scholarly journals Patients’ Perspective on Mental Health Specialist Video Consultations in Primary Care: Qualitative Preimplementation Study of Anticipated Benefits and Barriers (Preprint)

2019 ◽  
Author(s):  
Caroline Bleyel ◽  
Mariell Hoffmann ◽  
Michel Wensing ◽  
Mechthild Hartmann ◽  
Hans-Christoph Friederich ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Psychosocial Care ◽  
Care Practice ◽  
Service Users ◽  
Mental Health Specialist ◽  
Face To Face ◽  
Specialist Services ◽  
Health Specialist ◽  
Patients Perspective

BACKGROUND Due to limited access to specialist services, most patients with common mental disorders (depression or anxiety, or both) usually receive treatment in primary care. More recently, innovative technology-based care models (eg, video consultations) have been proposed to facilitate access to specialist services. Against this background, the PROVIDE (Improving Cross-Sectoral Collaboration Between Primary and Psychosocial Care: An Implementation Study on Video Consultations) project aims to improve the provision of psychosocial care through implementing video consultations integrated into routine primary care. OBJECTIVE From the patients’ perspective, this qualitative preimplementation study explored (1) anticipated benefits from and (2) barriers to implementing mental health specialist video consultations embedded in primary care services and (3) prerequisites for interacting with therapists via video consultations. METHODS Using a purposive (ie, stratified) sampling strategy, we recruited 13 patients from primary care practices and a tertiary care hospital (psychosomatic outpatient clinic) for one-off semistructured interviews. In a computer-assisted thematic analysis, we inductively (bottom-up) derived key themes concerning the practicability of mental health specialist video consultations. To validate our results, we discussed our findings with the interviewees as part of a systematic member checking. RESULTS Overall, we derived 3 key themes and 10 subthemes. Participants identified specific benefits in 2 areas: the accessibility of mental health specialist care (shorter waiting times: 11/13, 85%; lower threshold for seeking specialist mental health care: 6/13, 46%; shorter travel distances: 3/13, 23%); and the environment in primary care (familiar travel modalities, premises, and employees: 5/13, 38%). The main barriers to the implementation of mental health video consultations from the patients’ perspective were the lack of face-to-face contact (13/13, 100%) and technical challenges (12/13, 92%). Notably, participants’ prerequisites for interacting with therapists (12/13, 92%) did not seem to differ much from those concerning face-to-face contacts. CONCLUSIONS Mental health service users mostly welcomed mental health specialist video consultations in primary care. Taking a pragmatic stance, service users, who are often frustrated about uncoordinated care, particularly valued the embedment of the consultations in the familiar environment of the primary care practice. With respect to interventional studies and implementation, our findings underscore the need to minimize technical disruptions during video consultations and to ensure optimal resemblance to face-to-face settings (eg, by training therapists in consistently reacting to nonverbal cues). CLINICALTRIAL German Clinical Trials Register DRKS00012487; https://tinyurl.com/uhg2one

scholarly journals Cross-sectional study evaluating the association between integrated care and health-related quality of life (HRQOL) in Dutch primary care

BMJ Open ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. e040781
Author(s):  
Pim P Valentijn ◽  
Marcel Kerkhoven ◽  
Jantien Heideman ◽  
Rosa Arends
Keyword(s):  
Primary Care ◽  
Integrated Care ◽  
Primary Care Practice ◽  
Anxiety And Depression ◽  
Care Practice ◽  
Cross Sectional ◽  
Practice Population ◽  
Related Quality ◽  
Health Related

ObjectivesThe aim of this study was to evaluate the association between integrated care and health-related quality of life (HRQOL) in a primary care practice population.DesignA cross-sectional survey study.SettingPrimary care practice population.ParticipantsA sample (n=5562) of patients in two general practitioner practices in the Netherlands.Primary outcome measuresThe Rainbow Model of Integrated Care Measurement Tool patient version and EQ-5D was used to assess integrated service delivery and HRQOL. The association between integrated care and HRQOL groups was analysed using multivariate logistic regression.ResultsOverall, 933 respondents with a mean age of 62 participated (20% response rate) in this study. The multivariate analysis revealed that positive organisational coordination experiences were linked to better HRQOL (OR=1.87, 95% CI 1.18 to 2.95), and less anxiety and depression problems (OR=0.36, 95% CI 0.20 to 0.63). Unemployment was associated with a poor HRQOL (OR=0.15, 95% CI 0.08 to 0.28). Ageing was associated with more mobility (OR=1.06, 95% CI 1.04 to 1.09), self-care (OR=1.06, 95% CI 1.02 to 1.11), usual activity (OR=1.03, 95% CI 1.01 to 1.05) and pain problems (OR=1.02, 95% CI 1.01 to 1.04). Being married improved the overall HRQOL (OR=1.60, 95% CI 1.13 to 2.26) and decreased anxiety and depression (OR=0.47, 95% CI 0.31 to 0.72). Finally, females had a poor overall HRQOL (OR=1.67, 95% CI 0.48 to 0.93) and more pain and discomfort problems (OR=1.47, 95% CI 1.11 to 1.95).ConclusionThis study shows for the first time that organisational coordination activities are positively associated with HROQL of adult patients in a primary care context, adding to the evidence of an association between integrated care and HRQOL. Also, unemployment, ageing and being female are accumulating risk factors that should be considered when designing integrated primary care programmes. Further research is needed to explore how various integration types relate to HRQOL for people in local communities.

On the same page or in a different book? A pilot project on the perceptions of educational needs in an era of shifting mental health care to primary care (Preprint)

2021 ◽  
Author(s):  
Stephanie Sutherland ◽  
Dahn Jeong ◽  
Michael Cheng ◽  
Mireille St-Jean ◽  
Alireza Jalali
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Health Care ◽  
Mental Health Care ◽  
Medical Management ◽  
Family Physicians ◽  
Educational Needs ◽  
Health Conditions ◽  
Care Providers ◽  
Mental Health Conditions

BACKGROUND There is an unmet need for mental health care in Canada. Seventy-five percent of visits for mental health services are related to mood and anxiety disorder, which occur most frequently in the primary care setting. Primary care providers such as general practitioners and family physicians are essential part of mental health care services. However, it is currently not well known what is needed to increase care providers’ willingness, comfort and skills to adequately provide care. OBJECTIVE The aim of this study was to understand the caregiver and family physician needs regarding the care and medical management of individuals with mental health conditions. METHODS A needs assessment was designed to understand the educational needs of caregivers and family physicians with regard to the provision of mental health care, specifically, to seek advice of the format and delivery mode for an educational curriculum to be accessed by both stakeholder groups. Exploratory qualitative interviews were conducted and data was collected and analysed iteratively until thematic saturation was achieved. RESULTS Caregivers of individuals with mental health conditions (n=24) and family physicians (n=10) were interviewed. Both caregivers and family physicians expressed dissatisfaction with the status quo regarding the provision of mental health care at the family physician’s office. They stated that there was a need for more educational materials as well as additional supports. Caregivers expressed a general lack of confidence in family physicians to manage their son/daughter’s mental health condition, while family physicians sought more networking opportunities to improve and facilitate provision of mental health care. CONCLUSIONS Robust qualitative studies are necessary to identify the educational and medical management needs of caregivers and family physicians. Understanding each other’s perspectives is an essential first step to collaboratively designing, implementing, and the subsequent evaluation of community-based mental health care. Fortunately, there are initiatives underway already to address these need areas (e.g. websites such as eMentalHealth.ca/PrimaryCare as well as mentorship and collaborative care network) and information from this study can help inform the gaps in those existing initiatives. CLINICALTRIAL NA

Mental Health Care of Children and Adolescents: A Guide for Primary Care Clinicians

2018 ◽  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Health Care ◽  
Mental Health Care ◽  
Children And Adolescents ◽  
Primary Care Practice ◽  
Care Practice ◽  
Primary Care Clinicians

This indispensable resource provides vital guidance for integrating mental health care into your everyday primary care practice. https://shop.aap.org/mental-health-care-of-children-and-adolescents-a-guide-for-primary-care-clinicians-paperback/

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