Clinical trial NCT06581874: Evaluation of a Collaborative Mental Health Care System
Official title: Evaluation of a Collaborative Mental Health Care System
Study type: INTERVENTIONAL
Overall status: RECRUITING
Phase: NA
Conditions: Psychiatric Adults Patients
Keywords: psychiatry
outpatient follow-up
emergency
ehealth
collaborative care
Lead sponsor: Centre Hospitalier Intercommunal de Toulon La Seyne sur Mer
Sponsor class: OTHER
First posted: 2024-09-03
Enrollment: 478
Sex: ALL
Minimum age (years): 18
Standard ages: ADULT
OLDER_ADULT
Accepts healthy volunteers: no
Allocation: NON_RANDOMIZED
Intervention model: PARALLEL
Primary purpose: HEALTH_SERVICES_RESEARCH

Brief summary: In the absence of easy access to second-line ambulatory care, the number of 'inappropriate' psychiatric emergency visits is increasing, with emergency departments becoming the gateway to mental health care.

This is the context in which the 'med@psy' system was set up in the Toulon-Provence-Mediterranean metropolitan area by a private psychiatrist. It facilitates access to psychiatric second referral for General Practitioners (GPs) by pooling the 48-hour supply of psychiatric consultations in real time. It is assumed that this system will facilitate access to outpatient psychiatric care and help to optimize the organisation of patient care and follow-up. The aim of this study is to evaluate the med@psy system in the care pathway for patients with psychiatric disorders.

This study main objective is to compare the proportion of patients with a psychiatric disorder who will receive outpatient follow-up 1 month after a visit to a psychiatric emergency department without hospitalization (Group 1) versus 1 month after a consultation with a psychiatrist within 48 hours via the med@psy system (Group 2).

Detailed description: General practitioners (GPs) are the gateway to the healthcare system and therefore the first point of contact for mental health. A significant proportion of psychiatric disorders can be treated in primary care if GPs have easy access to psychiatric support. However, they are faced with difficulties in accessing secondary care. Around 9/10 consider that it is more difficult to obtain specialist advice than for other disciplines, and say they have difficulty referring a patient for mental health care.

In the absence of easy access to second-line ambulatory care, the number of 'inappropriate' psychiatric emergency visits is increasing, with emergency departments becoming the gateway to mental health care. It is recognized that the deployment of earlier and more graduated care reduces the intensity of disorders, prescriptions for time off work and psychotropic drugs, and hospitalizations.

A new, more preventive, efficient and cost-effective approach to mental health is emerging, with psychiatrists working closely with GPs. This is the context in which the 'med@psy' system was set up in the Toulon-Provence-Mediterranean metropolitan area by a private psychiatrist. It facilitates access to psychiatric second referral for GPs by pooling the 48-hour supply of psychiatric consultations in real time. We assume that this system will facilitate access to outpatient psychiatric care and help to optimize the organisation of patient care and follow-up. The aim of this study is to evaluate the med@psy system in the care pathway for patients with psychiatric disorders.

This study main objective is to compare the proportion of patients with a psychiatric disorder who will received outpatient follow-up 1 month after a visit to a psychiatric emergency department without hospitalization (Group 1) versus 1 month after a consultation with a psychiatrist within 48 hours via the med@psy system (Group 2).

Eligibility criteria: Inclusion Criteria:

* Patient ≥ 18 years ;
* Patient presenting to the Centre hospitalier de Toulon La Seyne sur Mer emergency department, with or without referral, and receiving psychiatric advice with discharge without hospitalization after clinical assessment (Group 1) or patients referred for psychiatric consultation via the Med@psy system (Group 2).
* Patient with indication for outpatient follow-up
* Patient with open social security rights

Exclusion Criteria:

* Patient's refusal to take part in research ;
* Patient currently being followed by a psychiatrist. Psychiatric follow-up is defined as at least one consultation with a psychiatrist in the last 3 months, outside an unscheduled care consultation or in an emergency department;
* Patients referred for a suicide attempt, violent or non-violent, serious or non-serious;
* Patients without a declared general practioner;
* Patients already included in the study;
* Patients who do not speak French;
* Patients under judicial protection (guardianship, curatorship, etc.) or safeguard of justice;
* Patient under compulsory care, under a care order or deprived of liberty.
* Any other reason which, in the investigator's opinion, could interfere

Primary outcomes:
measure: Number of patients with a consultation with a psychiatrist, a psychologist or a general practioner one month after the consultation via the med@psy system or the visit to emergency department
timeFrame: 1 month
Secondary outcomes:
measure: Outpatient follow-up at three months
timeFrame: 3 months
measure: Medical partners commitment (part 1)
timeFrame: 1 year
measure: Medical partners commitment (part 2)
timeFrame: 1 year
measure: Medical partners commitment (part 3)
timeFrame: 1 year
measure: Medical partners commitment (part 4)
timeFrame: 1 year
measure: Med@psy platform patients characteristics
timeFrame: 1 month
measure: Functioning Global Assessment
timeFrame: 3 months
Other outcomes:
Locations:
city: Toulon
country: France
facility: Cabinet médical Korrichi (Med@psy program linked to this office)
state: Var
city: Toulon
country: France
facility: Centre Hospitalier Intercommunal Toulon La Seyne sur Mer emergency reception service
state: Var
Study officials:
name: Fabien Korrichi, MD
role: STUDY_DIRECTOR
References:
citation: Truelove S, Ng V, Kates N, Alloo J, Sunderji N, Patriquin MJ. Les soins de sante mentale en collaboration: Mobiliser les systemes de sante pour soutenir une approche d'equipe. Can Fam Physician. 2023 Feb;69(2):86-88. doi: 10.46747/cfp.690286. No abstract available. French.
citation: Jones SH, Thornicroft G, Coffey M, Dunn G. A brief mental health outcome scale-reliability and validity of the Global Assessment of Functioning (GAF). Br J Psychiatry. 1995 May;166(5):654-9. doi: 10.1192/bjp.166.5.654.
citation: Kates N, Arroll B, Currie E, Hanlon C, Gask L, Klasen H, Meadows G, Rukundo G, Sunderji N, Ruud T, Williams M. Improving collaboration between primary care and mental health services. World J Biol Psychiatry. 2019 Dec;20(10):748-765. doi: 10.1080/15622975.2018.1471218. Epub 2018 Jun 20.