Understanding integrated mental health care in “real-world” primary care settings: What matters to health care providers and clients for evaluation and improvement?

Ion, Allyson; Sunderji, Nadiya; Jansz, Gwen; Ghavam-Rassoul, Abbas

doi:10.1037/fsh0000294

Cited by 21 publications

(22 citation statements)

References 34 publications

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“…At any rate, there is some evidence for a mounting gap between the empirical support for conventional integrated care approaches and the implementation of these models. 36 Thus, faster access to specialist mental healthcare has been promoted as a central asset of VCs for a long time. 37 40-43 This study has some limitations.…”

Section: Discussionmentioning

confidence: 99%

Health providers’ experiences with mental health specialist video consultations in primary care: a qualitative study nested within a randomised feasibility trial

et al. 2021

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ObjectiveDespite available effective treatments for mental health disorders, few patients in need receive even the most basic care. Integrated telepsychiatry services may be a viable option to increase access to mental healthcare. The aim of this qualitative process evaluation embedded in a randomised controlled feasibility trial was to explore health providers’ experiences with a mental healthcare model integrating mental health specialist video consultations (MHSVC) and primary care.MethodsA qualitative process evaluation focusing on MHSVC in primary care was conducted. In 13 semistructured interviews, we assessed the experience of all mental health specialists, primary care physicians and medical assistants who participated in the trial. A thematic analysis, focusing on the implementation, mechanisms of impact and context, was applied to investigate the data.ResultsConsidering (1) the implementation, participants evaluated the consultations as feasible, easy to use and time saving. Concerning (2) the mechanisms of impact, the consultations were regarded as effective for patients. Providers attributed the patients’ improvements to two key aspects: the familiarity of the primary care practice and the fast access to specialist mental healthcare. Mental health specialists observed trustful therapeutic alliances emerging and described their experience as comparable to same-room care. However, compared with same-room care, specialists perceived the video consultations as more challenging and sometimes more exhausting due to the additional effort required for establishing therapeutic alliances. Regarding (3) the intervention’s context, shorter travel distances for patients positively affected the implementation, while technical failures, that is, poor Internet connectivity, emerged as the main barrier.ConclusionsMHSVCs in primary care are feasible and successful in improving access to mental healthcare for patients. To optimise engagement and comfort of both patients and health providers, future work should focus on empirical determinants for establishing robust therapeutic alliances with patients receiving MHSVC (eg, leveraging non-verbal cues for therapeutic purposes).Trial registration numberDRKS00015812; Results.

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Section: Discussionmentioning

confidence: 99%

Health providers’ experiences with mental health specialist video consultations in primary care: a qualitative study nested within a randomised feasibility trial

et al. 2021

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“…The substantial amount of resources utilized to facilitate implementation, ranging from $208,314 to $236,263 per network excluding travel cost, is not surprising given the complexity of PCMHI [1,6,13], the difficulty of changing the structure and processes of care [15,39,40], the large number of contextual barriers that can hinder implementation [10,12,15,16,19], and the number of stakeholders that might need to be involved. Our study findings support the need to protect time for stakeholder participation in facilitation efforts.…”

Section: Discussionmentioning

confidence: 99%

Time and Organizational Cost for Facilitating Implementation of Primary Care Mental Health Integration

et al. 2019

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Background Integrating mental health services into primary care settings is complex and challenging. Although facilitation strategies have successfully supported implementation of primary care mental health integration and other complex innovations, we know little about the time required or its cost. Objective To examine the time and organizational cost of facilitating implementation of primary care mental health integration. Design Descriptive analysis. Participants One expert external facilitator and two internal regional facilitators who helped healthcare system stakeholders, e.g., leaders, managers, clinicians, and non-clinical staff, implement primary care mental health integration at eight clinics. Intervention Implementation facilitation tailored to the needs and resources of the setting and its stakeholders. Main Measures We documented facilitators’ and stakeholders’ time and types of activities using a structured spreadsheet collected from facilitators on a weekly basis. We obtained travel costs and salary information. We conducted descriptive analysis of time data and estimated organizational cost. Key Results The external facilitator devoted 263 h (0.09 FTE), including travel, across all 8 clinics over 28 months. Internal facilitator time varied across networks (1792 h versus 1169 h), as well as clinics. Stakeholder participation time was similar across networks (1280.6 versus 1363.4 person hours) but the number of stakeholders varied (133 versus 199 stakeholders). The organizational cost of providing implementation facilitation also varied across networks ($263,490 versus $258,127). Stakeholder participation accounted for 35% of the cost of facilitation activities in one network and 47% of the cost in the other. Conclusions Although facilitation can improve implementation of primary care mental health integration, it requires substantial organizational investments that may vary by site and implementation effort. Furthermore, the cost of using an external expert to transfer facilitation skills and build capacity for implementation efforts appears to be minimal.

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“…For example, according to German health insurance claims data, one in every 2 patients with two or more mental health conditions is treated by general practitioner (GP) only [4]. By increasing the access to specialist care, integrated care models are effective in ensuring seamless care trajectories [5][6][7][8]. However, in many remote and rural areas, mental health specialists (MHS), who play a pivotal role in these models, are not readily available [9].…”

Section: Telehealth In General Practice Mental Healthmentioning

confidence: 99%

Intent to Adopt Video-Based Integrated Mental Health Care and the Characteristics of its Supporters: Mixed Methods Study Among General Practitioners Applying Diffusion of Innovations Theory (Preprint)

Haun¹,

Stephan²,

Wensing³

et al. 2020

Preprint

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BACKGROUND Most people with common mental disorders, including many of those with severe mental illness, are treated in general practice. Video-based integrated care models featuring mental health specialist video consultations (MHSVC) facilitate the involvement of specialized mental healthcare. However, the potential uptake by general practitioners (GPs) is unclear. OBJECTIVE This mixed-method pre-implementation study aimed to (a) assess GPs’ intent-to-adopt MHSVC in their practice and (b) identify predictors for early intent-to-adopt (quantitative strand) and (c) characterise GPs with early intent-to-adopt based on the Diffusion of Innovations Theory (DOI) (qualitative strand). METHODS Applying a convergent parallel design, we combined a survey in 177 GPs followed up with focus groups and individual interviews in a sample of five early adopters and one non-adopter. We identified predictors for intent-to-adopt though a cumulative logit model for ordinal multicategory responses with proportional odds structure to the data. Two coders independently analysed the qualitative data deriving common characteristics across the five early adopters. We interpreted the qualitative findings accounting for the generalised adopter categories of the DOI. RESULTS This study found that (1) about one in two GPs assumed that patients benefit from a MHSVC service model, (2) about one in three GPs intended to adopt such a model, (3) the availability of a designated room was the only significant predictor for intent-to-adopt in GPs, and (4) supporting GPs expected to save time and took a solution-focused perspective on the practical implementation of MHSVC. Finally, (5) characteristics of supporting and non-supporting GPs in the context of MHSVC corresponded well with the generalized adopter categories conceptualized in the DOI. CONCLUSIONS There is a significant proportion of GPs who may function as early adopters and key stakeholders to facilitate the spread of MHSVC. Future work should focus on measures to foster the intention to adopt among hesitant GPs. CLINICALTRIAL German Clinical Trials Register DRKS00012487; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00012487.

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Understanding integrated mental health care in “real-world” primary care settings: What matters to health care providers and clients for evaluation and improvement?

Cited by 21 publications

References 34 publications

Health providers’ experiences with mental health specialist video consultations in primary care: a qualitative study nested within a randomised feasibility trial

Health providers’ experiences with mental health specialist video consultations in primary care: a qualitative study nested within a randomised feasibility trial

Time and Organizational Cost for Facilitating Implementation of Primary Care Mental Health Integration

Intent to Adopt Video-Based Integrated Mental Health Care and the Characteristics of its Supporters: Mixed Methods Study Among General Practitioners Applying Diffusion of Innovations Theory (Preprint)

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