EHealth tools for the optimisation of care for patients with mental disorders
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eHealth tools for the optimisation of care for patients with mental disorders. Hans Kordy Center for Psychotherapy Research, University of Heidelberg. 3rd Ministerial European eHealth Conference and Exhibition, Tromsoe, Norway, 2005. eHealth at the Centre for Psychotherapy Research.

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

Hans Kordy

Center for Psychotherapy Research, University of Heidelberg

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


eHealth at the Centre for Psychotherapy Research mental disorders

  • „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” mental disorders

  • A collaborative enterprise of various stakeholders:

  • Research: Forschungsstelle für Psychotherapie

  • Clinical Provider: Panorama-Klinik Scheidegg/Allgäu

  • Insurance/Payer: Techniker Krankenkasse


Project „Internet-Bridge“ - Background mental disorders

Need for step-down maintenance programmes

Patients with mental disorders

  • 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.


Project „Internet Bridge“ mental disorders

Strategy

  • Maintenance approach / relapse prevention

  • Group therapy in an Internet chat-room

  • Outcome monitoring


Project „Internet Bridge“ mental disorders

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 mental disorders

Participants

Hospital / Therapists

Center for PT Research / Server


Project „Internet Bridge“ mental disorders

Technical background

  • Server

  • Software

  • Technical administration and support

  • Homepage

  • Training of therapists and patients


Project „Internet Bridge“ mental disorders

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 mental disorders“

Continuous monitoring

  • Software: Web-Akquasi

  • Pre-session questionnaires (current impairment / symptoms)

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


AKQUASI - Outcome Monitoring mental disorders

continue therapy

(predominantly improvements)

Scale

State

Change

Last Change

Psychological distress

Physical impairment

Interpersonal impairment

Social impairment

Coping Resources

General life satisfaction

Project „Internet Bridge“

Continuous monitoring

  • Software: Web-Akquasi

  • Feedback on symptom status and change


Legal aspects mental disorders

Principle: avoid negligence!

  • data protection and privacy

  • professional standards / code of professional conduct

  • liability law

  • criminal law


Emergency measures mental disorders

  • 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)


Project „Internet Bridge mental disorders“ – The Study

Aims

  • Feasibility & Reliability

  • Acceptance

  • Effectiveness


Project „Internet Bridge“ mental disorders

Design

12-15 weekly

chat sessions

inpatient treatment

Chat

group

6-months

follow-up

12-months

follow-up

admission

discharge

inpatient treatment

Control

group

6-months

follow-up

12-months

follow-up

admission

discharge


Project „Internet Bridge“ mental disorders

Sample

- treatment group: N = 117 patients

- control group: N = 117 patients

- inpatient treatment

- stability at discharge from hospital

- internet access

- experienced group therapists:

  • . familiar with specific problems of the patients

  • . familiar with PC and chat


Project „Internet Bridge“ – Study design mental disorders

Sample - diagnosis


Project „Internet Bridge“ – Study results mental disorders

Acceptance

  • Interest for the offer 80%

  • Drop-out rate 13%

  • Session attendance 87%

  • Satisfaction with sessions 90%

  • - Satisfaction with programme 85%


Project „Internet Bridge“ – Study results mental disorders

Evaluation of the setting

- Session duration 74%

- Weekly sessions 80%

- Programme duration 55%

- Importance of the therapist 80%

- Importance of anonymity 38%

- Willingness to pay (privately) 51%


Project „Internet Bridge“ – Study results mental disorders

Effectiveness – main criterion: stability of therapeutic gains

discharge

6 months fu

12 months fu


Project „Internet Bridge“ – Study results mental disorders

Effectiveness – Psychological distress (SCL-90-R)


Project „Internet Bridge“ – Study results mental disorders

Effectiveness – Physical impairment (GBB)


Project „Internet Bridge“ - Conclusions mental disorders

Chat-groups....

....proved technically feasible

....are well accepted by patients

....promise effective relapse prevention


eHealth - Outlook mental disorders

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

....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 mental disorders

For further questions:

[email protected]

[email protected]


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