JMIR Publications

ABSTRACT

Background:

Most people suffering from depression and anxiety disorders are solely treated by their primary care physician. Access to specialized mental health care is impeded by patients’ comorbidity and immobility in ageing societies and long waiting times on the providers’ end. Video-based integrated care models may leverage limited resources more efficiently and provide timely specialized care in the primary care environment the patient is already familiar with.

Objective:

In an individually randomized controlled trial we aimed to evaluate the feasibility of mental health specialist video consultations with primary care patients with depression and/or anxiety disorder.

Methods:

Participants were recruited by their primary care physicians during regular practice visits. Eligible patients were required to experience at least moderate symptoms of depression and/or anxiety disorder. Patients were randomized in two groups receiving either treatment as usual as provided by their general practitioner or up to five video consultations conducted by a mental health specialist. Video consultations focused on (1) systematic diagnosis plus proactive monitoring using validated clinical rating scales, (2) the establishment of an effective working alliance and (3) a stepped-care algorithm within integrated care adjusting treatments based on clinical outcomes. Feasibility outcomes were recruitment, rate of loss to follow-up, acceptability of treatment and attendance at sessions. Effectiveness outcomes included depression (PHQ-9), anxiety (GAD-7), burden of specific somatic complaints (Somatic Symptom Disorder-B Criteria Scale, SSD-12), recovery (Recovery Assessment Scale, RAS-G), and perception of chronic illness care (Patient Assessment of Chronic Illness Care, PACIC–Short Form) – which were measured at baseline and 16 weeks post-allocation by assessors blinded to group allocation.

Results:

Fifty patients with depression and/or anxiety disorder were randomized, 23 to the intervention group and 27 to the treatment-as-usual group. The recruitment yield (number randomized per number screened) and consent rate (number randomized per number eligible) were 50/73 (68.5%) and 50/58 (86.2%), respectively. Concerning acceptability, 20 (87.0%) of the 23 in the intervention group completed the intervention. Of 108 planned video consultations, 102 (94.4%) were delivered. Follow-up rates were 95.7% and 85.2% for the intervention and the control group, respectively. Change from baseline scores at post-measurement for the “No Domination by Symptoms” domain of recovery (RAS-G) were somewhat higher for the intervention group compared to the control group (Mann-Whitney U-Test: rank-biserial r = 0.19 [-0.09; 0.46], P = .18). We did not detect any notable differences between the intervention group and the control group for the other effectiveness outcomes. We did not observe any serious adverse events related to the trial.

Conclusions:

The intervention and study procedures are feasible for patients, primary care practice staff, and mental health specialists. A sufficiently powered pragmatic trial on mental health specialist video consultations should be conducted to investigate effectiveness in routine care. Clinical Trial: German Clinical Trials Register (registration no. DRKS00015812).