Currently submitted to: Journal of Medical Internet Research
Date Submitted: Dec 20, 2019
Open Peer Review Period: Dec 20, 2019 - Feb 14, 2020
(currently open for review and needs more reviewers - can you help?)
Integration of mental health care within primary care via video consultation: A qualitative pre-implementation study exploring the perspectives of psychotherapists and psychiatrists
Many patients with mental disorders remain untreated. Video-based mental health care demonstrates comparable effectiveness to face-to-face treatments and is a promising mode for delivering specialized care in primary care. Nevertheless, professionals struggle with implementing video consultations in their daily practice. Specifically, little is known on mental health specialists’ acceptance of mental health video consultations in routine practice. The PROVIDE project aims to imPROve cross sectoral collaboration between primary and psychosocial care through implementing VIDEo consultations. To increase the uptake of video consultations, it is crucial to account for necessary prerequisites and tailor interventions to the needs of the target group prior to implementation.
The aim of this study was to explore the acceptance of video consultations embedded in primary care from mental health specialists’ perspectives in Germany.
We conducted a qualitative exploratory pre-implementation study in urban and rural counties. We held three semi-structured focus groups with 11 mental health specialists. We used qualitative content analysis combining an inductive-deductive approach applying the Tailored Implementation in Chronic Diseases framework to the text material which comprises individual health professional factors; patient factors; professional interactions; incentives and resources; capacity for organizational change; social, political, and legal factors and guideline factors.
Against the background of long waiting times and a shortage of mental health specialists especially in rural areas, participants valued video consultations as a potential means to improve access to mental health care. With respect to the TICD domains, the participants most often discussed individual health professional factors, followed by patient factors. All participants highlighted the importance of a trusting relationship between the patient and the therapist and doubted whether such a relationship can be established through video consultations (11/11, 100%). However, participants considered mental health specialist video consultations as particularly suited for patients in rural areas, those with impaired mobility and those who may otherwise remain untreated (6/11, 55%). Most participants expected video consultations to avoid tedious searching for an available therapist and travel time for the aforementioned patient groups and therefore improve access to specialized care for patients (7/11, 64%). Moreover, the participants expected video consultations to improve the collaboration with the family physician (6/11, 55%). Finally, participants identified organizational aspects, such as reliable scheduling, the duration of the individual consultation (9/11, 82%) and reimbursement conditions (7/11, 67%) as key drivers for the acceptance and adoption of the model.
While mental health specialists expect video consultations to improve access to specialized care for some patients, they consistently wonder whether such consultations can establish a trusting patient-therapist relationship. When implementing video consultations, these concerns should be addressed by training providers in managing technology-based treatment settings with extra regard to fostering the patients’ and therapists’ engagement. Clinical Trial: German Clinical Trials Register (DRKS00012487)
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