Mental Health eConsults

Mental Disorders Clinical Trial

Official title:

The Effects of Mental Health eConsults: A Clinic-level Randomized Trial

Clinical Trial Details — Status: Completed

Administrative data

• NCT number: NCT02527915
• Other study ID #: 1507S76668
• Status: Completed
• Phase: N/A
• Start date: August 2015
• Est. completion date: March 2017

Study information

• Verified date: October 2019
• Source: University of Minnesota
• Contact: n/a
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

The purpose of this study is to assess whether electronic consultations between primary care providers and psychiatrists affects mental health services delivered in primary care settings.

Description:

This study assesses the effects of electronic consultations (eConsults) between primary care providers and psychiatrists as a way to support the delivery of mental health services in primary care settings. The setting for the study are the primary care clinics of Allina Health.

The study uses a randomized rollout design. Across 45 primary care clinics, half of the clinics will be randomly assigned to receive access to eConsults at the start of the study. The other half of the clinics will provide care-as-usual for nine months, at which point they will also gain access to eConsults. Stratified randomization will be used, with stratification on whether primary care clinics have co-located specialty mental health services.

For primary care clinics that are given access to eConsults, the primary care providers in those clinics will have the option of ordering an eConsult on behalf of their patients, which will include specific questions about a particular patient's care. The request is routed to the service region's psychiatry pool, and the psychiatrists have the option of responding. If they choose to respond, the psychiatrist responds with their recommendations within one business day, and the PCP proceeds with care accordingly. The psychiatrist receives 0.75 work relative value units (wRVUs) for providing this service. All communications for the eConsult are routed through Allina's Epic system. Although patients will not be billed for eConsults over the course of the proposed research, some insurance plans do cover it and evidence of eConsult effectiveness may impel other insurers to cover the service.

The study will have two components. First, the investigators will collect web survey data from the primary care providers to assess how access to eConsults affects providers' perceptions of their support and skill for delivering mental health services to their patients. Second, the investigators will assess the effects of receiving eConsults at the patient level, by using data from the Electronic Medical Record system.

Recruitment information / eligibility

• Status: Completed
• Enrollment: 900000
• Est. completion date: March 2017
• Est. primary completion date: January 2017
• Accepts healthy volunteers: Accepts Healthy Volunteers
• Gender: All
• Age group: N/A and older

Eligibility

Inclusion Criteria:

• For the provider surveys, we will recruit all of the primary care providers who work in Allina's primary care clinics to participate in the surveys

• For the patient-level analysis, we will examine data from all patients seen in Allina's primary care clinics during the study period. We will include children and adults.

Exclusion Criteria:

• We will exclude patients from the patient-level analysis who have opted that their secondary data not be used by Allina for research purposes.

Related Conditions & MeSH terms

• Mental Disorders

Intervention

Other:
• Mental Health eConsults
Providers in primary care clinics who receive the intervention will be able to use electronic consultations (eConsults) with psychiatrists. If a primary care provider wishes to use eConsults, he/she will enter a specific question about a patient in the electronic medical record system and submit as an eConsult. A psychiatrist will review the question and the patient's record, and send a response back to the primary care provider within one business day.
• Care as usual
Providers in primary care clinics will deliver care as usual to their patients.

Locations

Country	Name	City	State
United States	Allina Health	Minneapolis	Minnesota

Sponsors (2)

Lead Sponsor	Collaborator
University of Minnesota	Allina Health System

Country where clinical trial is conducted

United States, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Other	Emergency department use, 1 month	Whether there was any emergency department use in the months after a primary care visit. Data will be extracted from the electronic medical record system.	1-month
Other	Emergency department use, 3 months	Whether there was any emergency department use in the three months after a primary care visit. Data will be extracted from the electronic medical record system.	3-month
Other	Psychotropic medication use, 1 month	Whether there was any psychotropic drug prescription and use in the month after a primary care visit. Data will be extracted from the electronic medical record system.	1-month
Other	Psychotropic medication use, 3 month	Whether there was any psychotropic drug prescription and use in the three months after a primary care visit. Data will be extracted from the electronic medical record system.	3-month
Other	Inpatient use, 1 month	Whether there was any emergency department use in the month after a primary care visit. Data will be extracted from the electronic medical record system.	1-month
Other	Inpatient use, 3 month	Whether there was any emergency department use in the three months after a primary care visit. Data will be extracted from the electronic medical record system.	3-month
Other	Confidence in depression treatment	Providers are asked about their levels of confidence in five aspects of depression treatment at the baseline web survey questionnaire and the 6-month followup survey. Survey data will be collected from up to 400 primary care providers.	Baseline and six months
Other	Skill in depression treatment	Providers are asked to assess their skill in four aspects of depression treatment at the baseline web survey questionnaire and the 6-month followup survey. Survey data will be collected from up to 400 primary care providers.	Baseline and six months
Primary	Use of eConsults	Whether an eConsult was actually ordered in a primary care visit for a mental health issue. Data will be extracted from the electronic medical record system.	Within one day of a primary care clinic visit
Secondary	Frequency of specialist consultation	Primary care providers report how often in the past 6 months they consult with a mental health specialist for help with a patient's mental health issues at the baseline web survey questionnaire and the 6-month followup survey. Survey data will be collected from up to 400 primary care providers.	Baseline and 6 months
Secondary	How easy to consult with specialist	Primary care providers report how easy it is in the past 6 months to consult with a mental health specialist for help with a patient's mental health issues at the baseline web survey questionnaire and the 6-month followup survey. Survey data will be collected from up to 400 primary care providers.	Baseline and 6 months
Secondary	Patient contact with a specialist, 1 month	Whether patients see a mental health specialist within a month after a primary care visit. Data will be extracted from the electronic medical record system.	1-month
Secondary	Patient contact with a specialist, 3 months	Whether patients see a mental health specialist within 3 months after a primary care visit. Data will be extracted from the electronic medical record system.	3-month
Secondary	Patient contact with a specialist, 6 months	Whether patients see a mental health specialist within 6 months after a primary care visit. Data will be extracted from the electronic medical record system.	6-month
Secondary	Change in depression symptoms	Depressive symptoms, as measured by the PHQ-9 at the office visit and again at a routine PHQ9 measurement within six months.	Baseline office visit to followup within 6 months
Secondary	Total cost of care, 1 month	Total health care spending one month after a primary care visit (including the primary care visit). Data will be extracted from the electronic medical record system.	1-month
Secondary	Total cost of care, 3 month	Total health care spending three months after a primary care visit (including the primary care visit). Data will be extracted from the electronic medical record system.	3-month
Secondary	Total cost of care, 6 month	Total health care spending six months after a primary care visit (including the primary care visit). Data will be extracted from the electronic medical record system.	6-month
Secondary	Providers get needed support for mental health care	Providers indicate agreement with whether they have adequate support for delivering five aspects of mental health care at the baseline web survey questionnaire and the 6-month followup survey. Survey data will be collected from up to 400 primary care providers.	Baseline and 6 months
Secondary	Any mental health service use, 2 week	Whether any mental health services (medication, counseling) were used after a primary care visit. Data will be extracted from the electronic medical record system.	2-week
Secondary	Any mental health service use, 1 month	Whether any mental health services (medication, counseling) were used after a primary care visit. Data will be extracted from the electronic medical record system.	1-month
Secondary	Any mental health service use, 3-month	Whether any mental health services (medication, counseling) were used after a primary care visit. Data will be extracted from the electronic medical record system.	3-month
Secondary	Any mental health service use, 6 month	Whether any mental health services (medication, counseling) were used after a primary care visit. Data will be extracted from the electronic medical record system.	6-months
Secondary	Provider-perceived patient access	Providers' perceptions of how quickly their patients are able to access needed specialty mental health services at the baseline web survey questionnaire and the 6-month followup survey. Survey data will be collected from up to 400 primary care providers.	Baseline and six months