Clinical trial NCT03508518: Improving Access to Psychiatric Care for Patients in Primary Care
Official title: Improving Access to Psychiatric Care and the Fluidity of Care Pathways for Patients Suffering From Mental Disorders in Primary Care in France: Evaluation of a Psychiatric Consultation-liaison System
Study type: INTERVENTIONAL
Overall status: TERMINATED
Phase: NA
Conditions: Mental Disorder
Keywords: Accessibility of health services
Access to psychiatric care
Consultation-liaison
General practitioner and psychiatrist collaboration
Care pathway
Lead sponsor: University Hospital, Toulouse
Sponsor class: OTHER
Collaborators: name: Ministry of Health, France
First posted: 2018-04-25
Enrollment: 151
Sex: ALL
Minimum age (years): 15
Standard ages: CHILD
ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: SUPPORTIVE_CARE

Brief summary: Getting a consultation with a psychiatrist within an appropriate time is one of the main issues reported by general practitioners (GP) for patients suffering from mental disorders in primary care. Consultation liaison in psychiatry is a system focused on general medicine-psychiatry collaboration. The aim of the present study is to evaluate the impact of the consultation-liaison on the adequacy of the access time to a psychiatric consultation according to the degree of urgency evaluated by the GP.

Detailed description: Faced with the saturation of the psychiatric care system, who recognizes the key role of the GP in mental health. Three-quarters of prescriptions for antidepressants and anxiolytics are performed by GPs, but less than one in four people with depression have been diagnosed and treated appropriately. The GPs describe difficulties in accessing psychiatric professionals and in particular to obtain a quick consultation with a psychiatrist. In different countries, psychiatric consultation-liaison (CL), centered on the collaboration of general medicine and psychiatry, have emerged. Two meta-analyzes and a Cochrane review were conducted on CL but no clinical trials were conducted in France. CL seems to improve patients' health at 3 months as well as their satisfaction and adherence to care. Results regarding the improvement of prescriptions from GP are encouraging. Better clinical trials are being requested and a need for medico-economic studies is also identified.

In France, a psychiatry CL was born in Toulouse in 2017, the "DSPP". The present study plans a 2 groups randomized clinical trial, one group of GPs having access to DSPP, the other not. For a period of 3 months, the GPs propose to any patient, for whom they want a psychiatric consultation, to participate in the study and address him/her to a psychiatrist. The DSPP is an evaluation center without long-term patient follow-up. Only patient referred by his/her GP can get into the DSPP.

Eligibility criteria: Inclusion Criteria:

* 15 years patient or older:
* presenting mental suffering or a frequent or severe mental disorder
* having consulted his GP who ask for psychiatric consultation
* having given its consent for the use of its medico-administrative data
* affiliated with the general health insurance scheme
* of which the GP is from Haute Garonne and is voluntary to participate in the study
* Free, informed and written consent signed by the participant and the investigator (at the latest on the day of inclusion and before any examination required by the research) and by one of the parents for minor participants

Exclusion Criteria:

* Patient with ongoing psychiatric follow-up
* Patient unable to answer questionnaires (unable to read or write)
* Patients receiving a measure of legal protection

Primary outcomes:
measure: Number of patients who had access to a consultation with a psychiatrist
timeFrame: 2 to 21 working days after inclusion
Secondary outcomes:
measure: Number of days between M0 (GP consultation) and M1 (psychiatric consultation)
timeFrame: 6 months
measure: Number of passages to psychiatric emergencies
timeFrame: 6 months
measure: Number of suicide attempts
timeFrame: 6 months
measure: Mental health status by Symptom Checklist (SCL)
timeFrame: date of inclusion, 1 month and 6 months after inclusion
measure: Mental health status by Patient Health Questionnaire (PHQ)
timeFrame: date of inclusion, 1 month and 6 months after inclusion
measure: Duration of prescription of different drugs
timeFrame: date of inclusion, 1 month and 6 months after inclusion
measure: Evaluation of compliance with antidepressant prescriptions
timeFrame: date of inclusion, 1 month and 6 months after inclusion
measure: Number of prescription treatment of mental disorders
timeFrame: date of inclusion, 1 month and 6 months after inclusion
measure: Employment status
timeFrame: 6 months
measure: Patient satisfaction
timeFrame: 1 month
measure: Quality of life with EuroQol scale
timeFrame: 6 months
measure: GP satisfaction
timeFrame: 6 months
measure: Incremental Cost-Utility
timeFrame: 6 months
measure: Cost-Effectiveness Ratios of Patient Management Strategies
timeFrame: 6 months
measure: Production costs
timeFrame: 6 months
Other outcomes:
Locations:
city: Toulouse
country: France
facility: University Hospital Toulouse
Study officials:
affiliation: University Hospital, Toulouse
name: Sophie Prébois, MD
role: PRINCIPAL_INVESTIGATOR
References: