ehealth tools for the optimisation of care for patients with mental disorders hans kordy center for...
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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
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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.)
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Project “Internet-Bridge”
A collaborative enterprise of various stakeholders:
-Research: Forschungsstelle für Psychotherapie
-Clinical Provider: Panorama-Klinik Scheidegg/Allgäu
-Insurance/Payer: Techniker Krankenkasse
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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
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- Maintenance approach / relapse prevention
- Group therapy in an Internet chat-room
- Outcome monitoring
Project „Internet Bridge“
Strategy
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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
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Project „Internet Bridge“- Connecting people
Participants
Hospital / TherapistsCenter for PT Research / Server
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Project „Internet Bridge“
Technical background
- Server
- Software
- Technical administration and support
- Homepage
- Training of therapists and patients
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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
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Project „Internet Bridge“
Continuous monitoring
- Software: Web-Akquasi
- Pre-session questionnaires (current impairment / symptoms)
- Post-session questionnaires (session evaluation items / satisfaction)
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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
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Legal aspects
Principle: avoid negligence!
- data protection and privacy
- professional standards / code of professional conduct
- liability law
- criminal law
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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)
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Aims
- Feasibility & Reliability
- Acceptance
- Effectiveness
Project „Internet Bridge“ – The Study
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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
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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
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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
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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%
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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%
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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
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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
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Effectiveness – Physical impairment (GBB)
Project „Internet Bridge“ – Study results
0
5
10
15
20
25
30
35
admission discharge 6-months 12-monthsChat
Control
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Chat-groups....
Project „Internet Bridge“ - Conclusions
....proved technically feasible
....are well accepted by patients
....promise effective relapse prevention
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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
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Invitation
For further questions: