JMIR Publications

ABSTRACT

Background:

Due to limited access to specialist services, most patients with mental health conditions usually receive treatment in primary care. More recently, innovative technology-based care models (e.g., video consultations) have been proposed to facilitate access to specialist services.

Objective:

From the patients’ perspective, this qualitative pre-implementation study explores (a) anticipated benefits from and (b) barriers to implementing mental health specialist video consultations embedded in primary care services and (c) prerequisites for interacting with therapists via video consultations.

Methods:

Using a convenience sampling strategy, we recruited 13 patients from primary care services and a tertiary care hospital for one-off semi-structured interviews. In a computer-assisted thematic analysis, we inductively (bottom-up) derived key themes concerning the practicability of mental health specialist video consultations. To validate our results, we discussed our findings with the interviewees as part of a systematic member checking.

Results:

Overall, we derived three key themes and ten subthemes. Participants identified specific benefits in two areas, namely the accessibility to mental health specialist care (shorter waiting times (11/13, 85%), overcoming stigma for seeking specialist mental health care (6/13, 46%), shorter travel distances (3/13, 23%)) and the environment in primary care (familiar travel modalities, premises, and employees (5/13, 38%)). The main barriers to the implementation of mental health video consultations from the patients’ perspective were the lack of face-to-face contact (13/13, 100%) and technical challenges (12/13, 92%). Notably, participants’ prerequisites for interacting with therapists (12/13, 92%) did not seem to differ much from those concerning face-to-face contacts.

Conclusions:

Mental health service users mostly welcome mental health specialist video consultations in primary care. Taking a pragmatic stance, service users, who are often frustrated about uncoordinated care, particularly value the embedment of the consultations in the familiar environment of the primary care practice. With respect to interventional studies and implementation, our findings underscore the need to minimize technical disruptions during video consultations as well as ensure optimal resemblance to face-to-face settings (e.g., by training therapists in consistently reacting to verbal cues). Clinical Trial: German Clinical Trials Register DRKS00012487; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00012487