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
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: