The Western Norway Mental Health Interface Study on Referral Letters

Study Overview
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Brief Summary
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The main object to this trial is to study the function of referral letters as a mean to coordinate the care process for adult people when referred from Primary Care to Specialised Mental Health Care. The study will explore if and to what degree the quality of these referral letters can be improved, and the potential improvement's impact on defined patient-, professional and organisational related outcomes. According to Medical Research Council guidelines for evaluating complex interventions, a stepwise design with the use of both qualitative and quantitative methods will be used to conduct a controlled intervention study.

Detailed Description
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The study is based on a stepwise progression including four steps. Within step one group interview with four mixed groups of health professionals (both Primary and Specialised Care), patient representatives and managers will be conducted. The groups will give input on firstly, what information they think is important to include in the referral letters, and secondly, what impact they think improved referral letters can have for the organisation and care within Specialised Mental Health Care. Within step two a validated check-list to assess the quality of referral letters will be developed. Within step three outcome measures will be developed and tested. Both step two and three will make use of the results from step one in addition to existing literature and testing. Step four is the intervention study where measures from the former steps will be used.

Official Title
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Interface Between Primary Care and Specialist Mental Health Care - the Referral Letters

Conditions
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Mental Disorders

Intervention / Treatment
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* Other: Quality improvement intervention


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Referral letters send from a GP to Public Specialised Mental Health Care Referrals for elective assessment or treatment Exclusion Criteria: Referral letters send from other health personnel Referrals for acute care (within 24 hours)

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Health Services Research
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Participating GPs<br>GPs working at randomly selected GP centers/offices within the region that are invited to participate and signs a written informed consent to participate. (N=30-40) | Other: Quality improvement intervention<br>* A complex intervention will be implemented within the group of GPs in the intervention group. It includes participation in defining criteria for good referral letters, information about the correlation between information in the referral letters and outcome, introduction to the guideline, and consecutive feedback on own preformance regarding content of referral letter and outcome for the patient.<br>|
| No Intervention: Control group<br>GPs working at randomly selected GP centers/office within the region that are not invited to participate, will form the control group. (N=30-40) | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Length of stay | From date of admission or onset of out-patient treatment until date of discharge (documented in Electronic Patient Record as end of treatment periode), assessed up to six months from admission. | Day of discharge assessed up to six months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Response time for referral letters in Specialised Mental Health Care | Unit of measure: Number of days from receiving a referral letter to the response letter is sent to the patient and the General Practitioner. The response time for all letters recieved in a six month periode before the intervention to improve the quality of referral letters will be compared with the response time after the intervention. | Referral letters will be followed for the duration of the assessment and prioritation process until response letter is sent, an expected avarage of 10 days. | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Referral letters, Mental Health, Health Service, Coordination, Adults