Clinical trial NCT02527915: Mental Health eConsults
Official title: The Effects of Mental Health eConsults: A Clinic-level Randomized Trial
Study type: INTERVENTIONAL
Overall status: COMPLETED
Phase: NA
Conditions: Mental Disorders
Lead sponsor: University of Minnesota
Sponsor class: OTHER
Collaborators: name: Allina Health System
First posted: 2015-08-19
Enrollment: 900000
Sex: ALL
Standard ages: CHILD
ADULT
OLDER_ADULT
Accepts healthy volunteers: yes
Allocation: RANDOMIZED
Intervention model: PARALLEL
Primary purpose: HEALTH_SERVICES_RESEARCH

Brief summary: The purpose of this study is to assess whether electronic consultations between primary care providers and psychiatrists affects mental health services delivered in primary care settings.

Detailed description: This study assesses the effects of electronic consultations (eConsults) between primary care providers and psychiatrists as a way to support the delivery of mental health services in primary care settings. The setting for the study are the primary care clinics of Allina Health.

The study uses a randomized rollout design. Across 45 primary care clinics, half of the clinics will be randomly assigned to receive access to eConsults at the start of the study. The other half of the clinics will provide care-as-usual for nine months, at which point they will also gain access to eConsults. Stratified randomization will be used, with stratification on whether primary care clinics have co-located specialty mental health services.

For primary care clinics that are given access to eConsults, the primary care providers in those clinics will have the option of ordering an eConsult on behalf of their patients, which will include specific questions about a particular patient's care. The request is routed to the service region's psychiatry pool, and the psychiatrists have the option of responding. If they choose to respond, the psychiatrist responds with their recommendations within one business day, and the PCP proceeds with care accordingly. The psychiatrist receives 0.75 work relative value units (wRVUs) for providing this service. All communications for the eConsult are routed through Allina's Epic system. Although patients will not be billed for eConsults over the course of the proposed research, some insurance plans do cover it and evidence of eConsult effectiveness may impel other insurers to cover the service.

The study will have two components. First, the investigators will collect web survey data from the primary care providers to assess how access to eConsults affects providers' perceptions of their support and skill for delivering mental health services to their patients. Second, the investigators will assess the effects of receiving eConsults at the patient level, by using data from the Electronic Medical Record system.

Eligibility criteria: Inclusion Criteria:

* For the provider surveys, we will recruit all of the primary care providers who work in Allina's primary care clinics to participate in the surveys
* For the patient-level analysis, we will examine data from all patients seen in Allina's primary care clinics during the study period. We will include children and adults.

Exclusion Criteria:

* We will exclude patients from the patient-level analysis who have opted that their secondary data not be used by Allina for research purposes.

Primary outcomes:
measure: Use of eConsults
timeFrame: Within one day of a primary care clinic visit
Secondary outcomes:
measure: Frequency of specialist consultation
timeFrame: Baseline and 6 months
measure: How easy to consult with specialist
timeFrame: Baseline and 6 months
measure: Patient contact with a specialist, 1 month
timeFrame: 1-month
measure: Patient contact with a specialist, 3 months
timeFrame: 3-month
measure: Patient contact with a specialist, 6 months
timeFrame: 6-month
measure: Change in depression symptoms
timeFrame: Baseline office visit to followup within 6 months
measure: Total cost of care, 1 month
timeFrame: 1-month
measure: Total cost of care, 3 month
timeFrame: 3-month
measure: Total cost of care, 6 month
timeFrame: 6-month
measure: Providers get needed support for mental health care
timeFrame: Baseline and 6 months
measure: Any mental health service use, 2 week
timeFrame: 2-week
measure: Any mental health service use, 1 month
timeFrame: 1-month
measure: Any mental health service use, 3-month
timeFrame: 3-month
measure: Any mental health service use, 6 month
timeFrame: 6-months
measure: Provider-perceived patient access
timeFrame: Baseline and six months
Other outcomes:
measure: Emergency department use, 1 month
timeFrame: 1-month
measure: Emergency department use, 3 months
timeFrame: 3-month
measure: Psychotropic medication use, 1 month
timeFrame: 1-month
measure: Psychotropic medication use, 3 month
timeFrame: 3-month
measure: Inpatient use, 1 month
timeFrame: 1-month
measure: Inpatient use, 3 month
timeFrame: 3-month
measure: Confidence in depression treatment
timeFrame: Baseline and six months
measure: Skill in depression treatment
timeFrame: Baseline and six months
Locations:
city: Minneapolis
country: United States
facility: Allina Health
state: Minnesota
Study officials:
affiliation: University of Minnesota
name: Ezra Golberstein, Ph.D.
role: PRINCIPAL_INVESTIGATOR
References: