scholarly journals Clinical Outcomes of Asynchronous v Synchronous Telepsychiatry in Primary Care: A Randomized Clinical Trial. (Preprint)

2020 ◽  
Author(s):  
Peter M Yellowlees ◽  
Michelle Burke Parish ◽  
Alvaro D Gonzalez ◽  
Steven R Chan ◽  
Donald M Hilty ◽  
...  
Keyword(s):  
Primary Care ◽  
Clinical Trial ◽  
Health Outcomes ◽  
Randomized Clinical Trial ◽  
Clinical Outcomes ◽  
Primary Care Physicians ◽  
Drop Out ◽  
Global Functioning ◽  
Spanish Speaking

BACKGROUND Asynchronous Telepsychiatry (ATP) consultations (delayed time) can extend psychiatric expertise into primary care, and across languages. OBJECTIVE This is the first clinical outcomes study of ATP compared with Synchronous (real time) Telepsychiatry (STP), the current gold standard telepsychiatry “usual care” method. We hypothesized that patients in the ATP arm would show a better clinical trajectory than those in the STP arm as measured by clinician and patient self-reported ratings of depression, global functioning and health outcomes. METHODS In this randomized clinical trial 36 Primary Care Physicians (PCP) referred a heterogeneous sample of 401 treatment seeking adult depressed or anxious patients over a 5- year period from 3 primary care clinics. 184 English and Spanish speaking participants were enrolled and randomized, of whom 160 (80 ATP, 80 STP) completed baseline evaluations and were entered into the 2-year follow up study. Patients were treated by their PCPs in consultation with University of California Davis Health (UCDH) psychiatrists who consulted with the patients every 6 months for up to 2 years using ATP or STP and then made treatment recommendations to the PCP’s. Patients’ depression, clinical global functioning and health outcomes were assessed every 6 months using both clinician (primary outcomes) and patient (secondary outcomes) self-reported ratings. RESULTS Patients in both ATP and STP groups had significant improvements at 6- and 12-month follow-up on both clinician-rated outcomes. There were no significant differences in improvement between ATP and STP on any clinician or patient self-reported ratings at any follow-up. Drop-out rates at 1 year were 63/160, and at 2 years were 114/143, all somewhat higher for STP than ATP. 19% of the CONCLUSIONS This trial provides evidence of the clinical validity of ATP in English and Spanish speaking primary care patients and may be a key part of a stepped series of mental health interventions available within the primary care treatment setting. ATP presents a possible solution to the workforce shortage of psychiatrists and to the provision of mental healthcare in the home. CLINICALTRIAL NCT02084979

Effectiveness of a conversational chatbot in the smartphone to cease smoking in the adult population: pragmatic, controlled, randomized clinical trial in primary care (Dejal@). (Preprint)

2021 ◽  
Author(s):  
EDUARDO OLANO-ESPINOSA ◽  
Jose Francisco Avila-Tomas ◽  
Cesar Minue-Lorenzo ◽  
Blanca Matilla Pardo ◽  
Encarnación Serrano-Serrano ◽  
...  
Keyword(s):  
Primary Care ◽  
Clinical Trial ◽  
Clinical Practice ◽  
Randomized Clinical Trial ◽  
Control Group ◽  
Evidence Based ◽  
Intention To Treat ◽  
Usual Clinical Practice ◽  
Treat Analysis

BACKGROUND The magnitude and severity of smoking, the benefits of quitting, and the existence of effective and efficient interventions make it a priority problem. Health professionals intervene less than they should, and the most effective interventions are more expensive, require specific training and more time, which is a disadvantage for the service provider and for the accessibility of the services. Information and communication technologies avoid these problems thanks to their accessibility, privacy, customization possibilities, access to social support, and scalability. OBJECTIVE To assess the effectiveness of an evidence-based intervention to cease smoking via a chatbot in the smartphone compared to usual clinical practice in primary care. METHODS Pragmatic randomized clinical trial in 34 primary healthcare centers within the Madrid Health Service (Spain). Smokers over 18 years of age who attended on-site consultation and accepted help to quit tobacco were recruited by their doctor or nurse and randomly allocated to receive usual care (control group, CG) or an evidence-based chatbot intervention (intervention group, IG). The interventions in both arms were based on the 5A´s by the US clinical practice guideline, which combines behavioral and pharmacological treatments and is structured in several follow-up appointments. The primary outcome was continuous abstinence from smoking that was biochemically validated after 6 months by the collaborators. The outcome analysis was blinded to allocation of subjects although participants were unblinded to group assignment. An intention-to-treat analysis, entering the basal observation carried forward in cases of missing data, and logistic regression models with robust estimators were employed for assessing the primary outcomes. RESULTS The trial was conducted between October 1st of 2018 and March 31st of 2019. The sample comprised 513 patients (242 in the IG and 271 in the CG), with an average age of 49.8 years (SD 10.82) and gender ratio of 59.3% women and 40.7% men. Of them, 232 patients (45.2%) completed the follow-up, 104 (42.9%) in the IG and 128 (47.2%) in the CG. Main outcome: In the intention-to-treat analysis, the biochemically-validated abstinence rate at 6 months was higher in the IG with 26.03% (63/242) versus 18.82% (51/271) in the CG (odds ratio (OR)=1.52, 95% CI: 1.00–2.31, P=.05). After adjusting for basal CO-oxymetry and bupropion intake, no substantial changes were observed (OR=1.52, 95% CI 0.99–2.33 P= .053; pseudo R2=0.045). In the IG, 61.16% (148/242) of users accessed the chatbot, average bot-patient interaction time was 121 minutes (CI 95% 121.1–140.0), and average number of contacts was 45.56 (SD 36.32). CONCLUSIONS A treatment including a chatbot for helping in tobacco cessation was more effective than usual clinical practice in primary care. CLINICALTRIAL ClinicalTrials.gov, reference number NCT 03445507.

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