10th Feb 2014

Video conference for Collaborative Care and treatment of depression

Increased cooperation was needed between the different healthcare providers in order to optimise care for patients suffering from depression. In this optimisation laid the provision of equal access to specialised care for patients and to specialised knowledge for healthcare providers regardless of geographical or organisational location, increased level of competence for primary care as well as increased quality of care through knowledge sharing and support from specialists.

The aim of this intervention was to assess the impact of videoconference for Collaborative Care and direct treatment of depression. Alongside the intervention, the project aimed to develop clinical pathways for the use of video conference in the following setups:

  • Treatment for depression facilitated by video conference between specialists and/or primary care without the patient. The purpose of these meetings could be that the specialist guides the primary care professional in use of cCBT, or that they together assessed a patient’s medication, plan treatment of a patient, etc.
  • Treatment for depression facilitated by video conference between specialist and primary care with the patient present. The purpose of the meetings was to provide specialist support directly at the moment of treatment.
  • Follow-up or outpatient care of the patient at home. In this case, the healthcare professional communicated with the patient, who was at home. The healthcare professional could be either a GP, specialist, or other relevant healthcare professional depending on the location. This could be as a follow-up to cCBT treatment or face-to-face treatment.
  • Acute care. This is video conference from the acute ward to a specialist. Together with the patient, a plan was made for treatment of the patient, e.g. to decide if admission was necessary. By reducing unnecessary admissions, we saved both resources in the healthcare system, and avoided an unnecessary burden on the patient.By implementing video conference services at scale, this intervention aimed to ensure the appropriate balance between specialisation and proximity in order to provide the best care possible.

How it worked.
Some patients were also receiving treatment at home. These patients with depressive symptoms were referred by a GP to specialised mental healthcare. After the intake and a diagnosis for depression the therapist made a treatment plan with the patient. The therapist introduced the patient to the system for video conference and set up an account. The therapist and patient together made appointments for face to face sessions, home visits and video conference sessions with the patient at home.The pilots were classified into the following groups, depending on their focus. Note that there was some overlap of pilot sites between groups, as some pilots would implement several different solutions.

  • We also wanted to use video conference in acute care. Many acute admissions to psychiatric wards occurred outside normal working hours. Often the reason was that the GPs and the patients, their family or local officials were in a critical situation. The problem was that neither the GP, patient, or relatives had a contingency plan that was perceived as secure. Therefore, the only secure action was to admit the patient either voluntarily or if that was not possible, the GP could try to admit by force. In some instances, this might not be necessary and could be avoided by closer follow up with video consultation between GP, patient, and specialist healthcare, by pre-arranged admission if things got more difficult or by admission on daytime the next day. In that way some costly, unnecessary, and uncomfortable admissions might have been avoided.
  • We used video conference in different ways to improve care for citizens with depression. Video conference could be used between a GP and a specialist to discuss treatment for patients. In some cases, patients could also participate in the video conferences along with the GP. At the consultation, the involved parties decided on further plans for treatment. If the involved parties decided that the patient should not be admitted or followed up only by the specialist health care, the GP note this in the patient’s dossier to ensure that the treatment responsibility was clearly defined as belonging to the GP. On the other hand, if the involved parties decided that the patient should be admitted to the ward or be followed up primary by the specialist, the responsibility must formally be transferred to the specialist health care system.
  • Many European countries had already invested in video conference equipment and infrastructure. In the project, this investment was further capitalised on through greater utilisation. By use of video conference, care was made more available, and the course of treatment might be carried out as a cooperation between the GP, a psychiatrist, and any other relevant healthcare professional. By increasing cooperation (Collaborative Care) between the different healthcare providers, MasterMind aimed to assess the impact of video conference on treatment for depression patients. This was done by using video conference-based communication for creating a closer link between healthcare providers (the highly specialised level of care and the generalist care) for the delivery of treatment, care, and learning.
  • Group A was treatment for depression facilitated by video conference between specialists and/or GPs / other healthcare professionals without the patient. The purpose of these meetings could be that the specialist guided other healthcare professionals in the use of cCBT, or that they together assessed a patient’s medication, plan treatment, etc.
  • Group B was treatment for depression facilitated by video conference between specialist and GP with the patient present. The purpose of the meeting was to provide specialist support directly at the moment of treatment.
  • Group C was follow-up or outpatient care of the patient at home. In this case, the healthcare worker communicated with the patient, who was at home. The healthcare worker could be either a GP, specialist, or other healthcare professional depending on the location. This could be as a follow-up to cCBT treatment, face-to-face treatment, etc.
  • Group D was acute care. This was a video conference from the acute ward to a specialist. Together with the patient, they made a plan for the patient, e.g. decided if admission was necessary. By reducing unnecessary admissions, we saved both resources in the healthcare system, and avoided an extra burden on the patient.

The following table shows to which group(s) the different pilots belonged:

 

WP7 groups