ImPROving cross-sectoral collaboration between primary and psychosocial care:
An implementation study on VIDEo consultations (PROVIDE)

Deutsch

Aim, concept and treatment model of PROVIDE

Aim and concept

The project aims to improve the provision of psychosocial health care in primary care for the increasing number of underserved patients suffering from depression and/or anxiety. Demographic change will accelerate the need to respond to rising immobility and higher physical-mental health comorbidity. Integrated behavioural health (Crowley et al., Annals of Internal Medicine, 2015), involving primary care and specialist care providers, effectively addresses these challenges. However, there is a gap between proven evidence and real practice, especially in smaller practices and in Germany. In this project, collaboration of primary care physicians and mental health specialists applying video consultations within the premises of primary practices will address uptake of recommended treatment, symptom reduction, and resource utilisation. Video consultations will focus on diagnostics, care planning, and crisis management or brief psychotherapy.

In a first stage of this study, stakeholders will be investigated concerning potential barriers for change to tailor integrated behavioural health to their needs. Second, within a pilot study, this care model will be delivered and evaluated regarding feasibility. Finally, after care model optimisation, a randomised controlled trial with continuous implementation monitoring will assess the clinical effect of video-based care and compare the outcomes with those obtained in usual care. We expect that the approach will increase interdisciplinary collaboration and reduce symptom burden without expanding existing services.

Treatment model: How are patients being treated in general practice?

The PROVIDE treatment model, developed on the basis of the needs assessment (PROVIDE-A), involves primary care patients suffering from depressive and/or anxiety disorders being treated by psychotherapists via video consultation. The intervention consists of 5 sessions and includes diagnosis, treatment planning, and short-term intervention by the psychotherapist, depending on the patient's needs. Close interaction between the psychotherapist and the primary care provider ensures that the patient continues to connect to psychological care after the intervention is completed. During the video consultation, the patient is alone in a designated protected room in the primary care practice. In 2019, the treatment model was successfully tested and deemed feasible and safe to implement by all stakeholders (PROVIDE-B). Primary care providers and psychotherapists considered it to be easily integrated into everyday care and a useful addition to existing care.
Currently, the model is being investigated with regard to effectiveness and symptom improvement in a large supraregional randomised controlled trial.

Target population: Which patients are suitable for the treatment model?

People with depression and/or anxiety are considered to be particularly suitable for video consultations in general practice conducted by mental health specialists. (Backhaus et al., Psychological Services, 2012; Kessler et al., Lancet, 2009; Kocsis & Yellowlees, Telemedicine and e-Health, 2017).

Benefits and opportunities

Longer travel distances for patients and health care providers, especially in rural areas, may be saved with video consultations as an alternative mode of treatment delivery. Moreover, patients with mental disorders have the opportunity to receive specialized mental health care in a familiar environment. Many patients experience video consultations as comfortable and as a good starting point to establish a reliable therapeutic relationship (Kocsis & Yellowlees, Telemedicine and e-Health, 2017; Simpson et al., British Journal of Guidance & Counselling, 2009).

Risks

Previous studies have shown that video consultations do not negatively affect the therapeutic alliance per se. In general, communication works well and quite satisfactory (Hilty et al., Telemedicine and e-Health, 2013). Nevertheless, for a technology-based treatment approach such as video consultations, technical faults are possible. This, in addition to deliver better health care for patients, it is another aim of PROVIDE to implement a secure, user-friendly and organisationally practical technical platform for the realisation of video consultations at the interface between primary care and specialized mental health care. Therefore, possible disruptions of the therapeutic process due to technical faults will be reduced to a minimum and be subject to a critical incident reporting system.

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