ehealth tools for the optimisation of care for patients with mental disorders hans kordy center for...

eHealth tools for the optimisation of care for patients with mental disorders

Hans KordyCenter for Psychotherapy Research, University of Heidelberg

3rd Ministerial European eHealth Conference and Exhibition, Tromsoe, Norway, 2005

eHealth at the Centre for Psychotherapy Research

•„Internet-Bridge“: maintenance group setting (Valiollah Golkaramnay, Dipl.-Psych., Severin Haug, Dipl.-Psych.)

•„e-mail Bridge“: maintenance individual setting (Markus Wolf, Dipl.-Psych.)

•„Relapse prevention through SMS-Monitoring“ (Stephanie Bauer, PhD)

•„Web-AKQUASI“: quality management & outcome monitoring (Robert Percevic, PhD, Christine Gallas, Dipl.-Psych.)

Project “Internet-Bridge”

A collaborative enterprise of various stakeholders:

-Research: Forschungsstelle für Psychotherapie

-Clinical Provider: Panorama-Klinik Scheidegg/Allgäu

-Insurance/Payer: Techniker Krankenkasse

Project „Internet-Bridge“ - Background

- benefit substantially from inpatient care

- are at high risk to lose achieved gains

- wish to continue treatment

- are recommended to do so

- but, current service conditions make this difficult.

Patients with mental disorders

Need for step-down maintenance programmes

- Maintenance approach / relapse prevention

- Group therapy in an Internet chat-room

- Outcome monitoring

Project „Internet Bridge“

Strategy

Project „Internet Bridge“

Clinical concept - group setting

- 8–10 participants (disorder unspecific)

- open groups

- programme duration: 12-15 weekly sessions

- session duration: 90 min.

- groups are guided by experienced group therapists

Project „Internet Bridge“- Connecting people

Participants

Hospital / TherapistsCenter for PT Research / Server

Project „Internet Bridge“

Technical background

- Server

- Software

- Technical administration and support

- Homepage

- Training of therapists and patients

Project „Internet Bridge“

Security and confidentiality

- Chat-room: password-protected

- Online questionnaires: password-protected

- Passwords: changing regularly

- Communication: pseudonyms

- Data transfer: encoded (SSL)

- Server: firewall

Project „Internet Bridge“

Continuous monitoring

- Software: Web-Akquasi

- Pre-session questionnaires (current impairment / symptoms)

- Post-session questionnaires (session evaluation items / satisfaction)

Project „Internet Bridge“

Psychological distress

Physical impairment

Interpersonal impairment

Social impairment

Coping Resources

General life satisfaction

Scale State ChangeLast Change

AKQUASI - Outcome Monitoring

continue therapy(predominantly improvements)

Continuous monitoring

- Software: Web-Akquasi

- Feedback on symptom status and change

Legal aspects

Principle: avoid negligence!

- data protection and privacy

- professional standards / code of professional conduct

- liability law

- criminal law

Emergency measures

- face-to-face diagnosis at beginning

- Hospital emergency service (24 hours)

- Therapist’s telephone – 90 min after session

- Check of health/mood status at logout

- Local emergency contact (e.g. primary carer)

Aims

- Feasibility & Reliability

- Acceptance

- Effectiveness

Project „Internet Bridge“ – The Study

Design

Project „Internet Bridge“

inpatient treatment12-15 weeklychat sessions

admission

admission

discharge

discharge

12-monthsfollow-up

Chatgroup

Controlgroup

6-monthsfollow-up

12-monthsfollow-up

6-monthsfollow-up

inpatient treatment

Sample

Project „Internet Bridge“

- inpatient treatment

- stability at discharge from hospital

- internet access

- experienced group therapists:

. familiar with specific problems of the patients

. familiar with PC and chat

- treatment group: N = 117 patients

- control group: N = 117 patients

Sample - diagnosis

Project „Internet Bridge“ – Study design

0,0 10,0 20,0 30,0 40,0 50,0 60,0

F5

F4

F6

F3

Chatgr Verglgr

Acceptance

Project „Internet Bridge“ – Study results

- Interest for the offer 80%

- Drop-out rate 13%

- Session attendance 87%

- Satisfaction with sessions 90%

- Satisfaction with programme 85%

Evaluation of the setting

Project „Internet Bridge“ – Study results

- Session duration 74%

- Weekly sessions 80%

- Programme duration 55%

- Importance of the therapist 80%

- Importance of anonymity 38%

- Willingness to pay (privately) 51%

Effectiveness – main criterion: stability of therapeutic gains

Project „Internet Bridge“ – Study results

25

22,1

14,3

38,70

34,6

11,8

0 10 20 30 40 50

controlchat

discharge

6 months fu

12 months fu

Effectiveness – Psychological distress (SCL-90-R)

Project „Internet Bridge“ – Study results

0

0,2

0,4

0,6

0,8

1

1,2

admission discharge 6-months 12-monthsChat

Control

Effectiveness – Physical impairment (GBB)

Project „Internet Bridge“ – Study results

0

5

10

15

20

25

30

35

admission discharge 6-months 12-monthsChat

Control

Chat-groups....

Project „Internet Bridge“ - Conclusions

....proved technically feasible

....are well accepted by patients

....promise effective relapse prevention

E-Health tools such as internet chat-groups contribute to the optimisation of care through....

eHealth - Outlook

....facilitating access (bridges geografical and

psychosocial distances)

....extending the reach of specialists

....increasing the flexibility of care and carers

....improving the match between patients needs

and provided care

Invitation

For further questions:

Kordy@psyres-stuttgart.de

Bauer@psyres-stuttgart.de