Clinical efficacy of a Decision Support Tool (Link-me) to guide intensity of mental health care in primary practice: a pragmatic stratified randomised controlled trial

Fletcher, Susan; Spittal, Matthew J; Chondros, Patty; Palmer, Victoria; Chatterton, Mary Lou; Densley, Konstancja; Potiriadis, Maria; Harris, Meredith; Bassilios, Bridget; Burgess, Philip; Mihalopoulos, Cathrine; Pirkis, Jane; Gunn, Jane

doi:10.1016/s2215-0366(20)30517-4

Cited by 30 publications

(42 citation statements)

References 22 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A total of 20 studies were included in this review. The characteristics of the studies are summarized in Table 1, and more details on individual studies are provided in Multimedia Appendix 2 [15,35,[41][42][43][44][45][46][47][48][49][50][51][52][53][54][55][56][57][58]. The 20 studies included a comparative effectiveness trial of an interactive voice recording (IVR) intervention in a safety net population and a series of post hoc analyses on the same study population [41][42][43][44], a randomized trial of an internet support group with an associated subgroup analysis [45,46], 30% (6/20) other randomized trials [35,[47][48][49][50][51][52], a nonrandomized trial [53], 25% (5/20) implementation trials without a comparator [15,[54][55][56][57], and a qualitative exploratory study [58].…”

Section: Summary Of Studiesmentioning

confidence: 99%

“…Most studies identified by this review implemented or assessed multiple technologies at once rather than a single intervention. Of the 20 studies, 5 (25%) [15,50,53,54,57,58] assessed mobile apps, and 5 (25%) used a web-based platform [46,[49][50][51][52]. Adewuya et al [47] and Jin and Wu [48] used SMS text messaging as a core feature of the intervention, although other investigators used SMS text messaging as an adjunctive tool [51,53,59].…”

Section: Digital and Mobile Health Technologies In CCmentioning

confidence: 99%

“…One of the research groups [41][42][43][44]48] used technology to facilitate the screening of patients into CC by SMS text messages and IVR. Of the 20 studies, 1 (5%) described a decision support tool to triage patients into different levels of care [52]. Studies also used technology to facilitate measurement-based care by collecting clinical assessments [48,51,53,54].…”

Section: Digital and Mobile Health Technologies In CCmentioning

confidence: 99%

See 2 more Smart Citations

Digital and Mobile Health Technology in Collaborative Behavioral Health Care: Scoping Review

Moon¹,

Sobolev²,

Kane³

2022

JMIR Ment Health

View full text Add to dashboard Cite

Background The collaborative care model (CoCM) is a well-established system of behavioral health care in primary care settings. There is potential for digital and mobile technology to augment the CoCM to improve access, scalability, efficiency, and clinical outcomes. Objective This study aims to conduct a scoping review to synthesize the evidence available on digital and mobile health technology in collaborative care settings. Methods This review included cohort and experimental studies of digital and mobile technologies used to augment the CoCM. Studies examining primary care without collaborative care were excluded. A literature search was conducted using 4 electronic databases (MEDLINE, Embase, Web of Science, and Google Scholar). The search results were screened in 2 stages (title and abstract screening, followed by full-text review) by 2 reviewers. Results A total of 3982 nonduplicate reports were identified, of which 20 (0.5%) were included in the analysis. Most studies used a combination of novel technologies. The range of digital and mobile health technologies used included mobile apps, websites, web-based platforms, telephone-based interactive voice recordings, and mobile sensor data. None of the identified studies used social media or wearable devices. Studies that measured patient and provider satisfaction reported positive results, although some types of interventions increased provider workload, and engagement was variable. In studies where clinical outcomes were measured (7/20, 35%), there were no differences between groups, or the differences were modest. Conclusions The use of digital and mobile health technologies in CoCM is still limited. This study found that technology was most successful when it was integrated into the existing workflow without relying on patient or provider initiative. However, the effect of digital and mobile health on clinical outcomes in CoCM remains unclear and requires additional clinical trials.

show abstract

Section: Summary Of Studiesmentioning

confidence: 99%

Section: Digital and Mobile Health Technologies In CCmentioning

confidence: 99%

Section: Digital and Mobile Health Technologies In CCmentioning

confidence: 99%

See 1 more Smart Citation

Digital and Mobile Health Technology in Collaborative Behavioral Health Care: Scoping Review

Moon¹,

Sobolev²,

Kane³

2022

JMIR Ment Health

View full text Add to dashboard Cite

show abstract

“…The current study supports further investigation into one such model to treat depression/anxiety. Beyond this, there is emerging evidence on the effectiveness of digital platforms that can be readily implemented across GP clinics to initially match treatments for depression/anxiety on the basis of patient needs (Fletcher et al, 2021a(Fletcher et al, , 2021b; though explicit step up/ down algorithms need to be further developed and examined. Another study has evaluated the effectiveness/cost-effectiveness of an alternative stepped care model for the treatment of depression/anxiety in the Australian primary care setting (Anderson et al, 2019).…”

Section: Implications Of the Findingsmentioning

confidence: 99%

Exploring the cost-effectiveness of a Dutch collaborative stepped care intervention for the treatment of depression and/or anxiety when adapted to the Australian context: a model-based cost-utility analysis

Lee

Harris

Whiteford

et al. 2021

Epidemiol Psychiatr Sci

View full text Add to dashboard Cite

Aims Depression and anxiety are among the most common mental health conditions treated in primary care. They frequently co-occur and involve recommended treatments that overlap. Evidence from randomised controlled trials (RCTs) shows specific stepped care interventions to be cost-effective in improving symptom remission. However, most RCTs have focused on either depression or anxiety, which limits their generalisability to routine primary care settings. This study aimed to evaluate the cost-effectiveness of a collaborative stepped care (CSC) intervention to treat depression and/or anxiety among adults in Australian primary care settings. Method A quasi-decision tree model was developed to evaluate the cost-effectiveness of a CSC intervention relative to care-as-usual (CAU). The model adapted a CSC intervention described in a previous Dutch RCT to the Australian context. This 8-month, cluster RCT recruited patients with depression and/or anxiety (n = 158) from 30 primary care clinics in the Netherlands. The CSC intervention involved two steps: (1) guided self-help with a nurse at a primary care clinic; and (2) referral to specialised mental healthcare. The cost-effectiveness model adopted a health sector perspective and synthesised data from two main sources: RCT data on intervention pathways, remission probabilities and healthcare service utilisation; and Australia-specific data on demography, epidemiology and unit costs from external sources. Incremental costs and incremental health outcomes were estimated across a 1-year time horizon. Health outcomes were measured as disability-adjusted life years (DALYs) due to remitted cases of depression and/or anxiety. Incremental cost-effectiveness ratios (ICERs) were measured in 2019 Australian dollars (A$) per DALY averted. Uncertainty and sensitivity analyses were performed to test the robustness of cost-effectiveness findings. Result The CSC intervention had a high probability (99.6%) of being cost-effective relative to CAU. The resulting ICER (A$5207/DALY; 95% uncertainty interval: dominant to 25 345) fell below the willingness-to-pay threshold of A$50 000/DALY. ICERs were robust to changes in model parameters and assumptions. Conclusions This study found that a Dutch CSC intervention, with nurse-delivered guided self-help treatment as a first step, could potentially be cost-effective in treating depression and/or anxiety if transferred to the Australian primary care context. However, adaptations may be required to ensure feasibility and acceptability in the Australian healthcare context. In addition, further evidence is needed to verify the real-world cost-effectiveness of the CSC intervention when implemented in routine practice and to evaluate its effectiveness/cost-effectiveness when compared to other viable stepped care interventions for the treatment of depression and/or anxiety.

show abstract

“…Specifically, an RCT evaluating an eHealth platform ( Target-D ) that aimed to support patients in managing depression found that digitally stratifying patients and providing matched interventions resulted in greater improvements in depressive symptoms over 3 months compared with usual care [ 18 ]. Similarly, an RCT of a similar digital decision support tool ( Link-me ) demonstrated that digitally facilitated stepped care resulted in greater improvements in psychological distress in general practice patients compared with usual care [ 19 ].…”

Section: Introductionmentioning

confidence: 99%

Mental Health Screening in General Practices as a Means for Enhancing Uptake of Digital Mental Health Interventions: Observational Cohort Study

Whitton¹,

Hardy²,

Cope³

et al. 2021

J Med Internet Res

View full text Add to dashboard Cite

Background Digital mental health interventions stand to play a critical role in managing the mental health impact of the COVID-19 pandemic. Thus, enhancing their uptake is a key priority. General practitioners (GPs) are well positioned to facilitate access to digital interventions, but tools that assist GPs in identifying suitable patients are lacking. Objective This study aims to evaluate the suitability of a web-based mental health screening and treatment recommendation tool (StepCare) for improving the identification of anxiety and depression in general practice and, subsequently, uptake of digital mental health interventions. Methods StepCare screens patients for symptoms of depression (9-item Patient Health Questionnaire) and anxiety (7-item Generalized Anxiety Disorder scale) in the GP waiting room. It provides GPs with stepped treatment recommendations that include digital mental health interventions for patients with mild to moderate symptoms. Patients (N=5138) from 85 general practices across Australia were invited to participate in screening. Results Screening identified depressive or anxious symptoms in 43.09% (1428/3314) of patients (one-quarter were previously unidentified or untreated). The majority (300/335, 89.6%) of previously unidentified or untreated patients had mild to moderate symptoms and were candidates for digital mental health interventions. Although less than half were prescribed a digital intervention by their GP, when a digital intervention was prescribed, more than two-thirds of patients reported using it. Conclusions Implementing web-based mental health screening in general practices can provide important opportunities for GPs to improve the identification of symptoms of mental illness and increase patient access to digital mental health interventions. Although GPs prescribed digital interventions less frequently than in-person psychotherapy or medication, the promising rates of uptake by GP-referred patients suggest that GPs can play a critical role in championing digital interventions and maximizing the associated benefits.

show abstract

Clinical efficacy of a Decision Support Tool (Link-me) to guide intensity of mental health care in primary practice: a pragmatic stratified randomised controlled trial

Cited by 30 publications

References 22 publications

Digital and Mobile Health Technology in Collaborative Behavioral Health Care: Scoping Review

Digital and Mobile Health Technology in Collaborative Behavioral Health Care: Scoping Review

Exploring the cost-effectiveness of a Dutch collaborative stepped care intervention for the treatment of depression and/or anxiety when adapted to the Australian context: a model-based cost-utility analysis

Mental Health Screening in General Practices as a Means for Enhancing Uptake of Digital Mental Health Interventions: Observational Cohort Study

Contact Info

Product

Resources

About