Transcript here> do not exceed two lines of text here

New developments in IMPARTS:
Integrating Mental and Physical Healthcare:
Research Training and Services
Website: www.kcl.ac.uk/iop/depts/pm/research/imparts
Follow us on Twitter @IMPARTSP
IMPARTS - recap
 AIM
To improve detection and management common mental
disorders in medical settings
- web-based screening interface
- patient-reported mental and physical health outcome
measurement
- embedded in routine clinical practice
- informs patient care and referral
IMPARTS informatics screening system:
Page 2
1. Patients arriving for appointment are
given information sheet explaining purpose of
screening
2. Patients log on to an Ipad in the waiting
room, using their Hospital ID and initials
3. Patients complete a series of short
questionnaires tailored to their condition
4. Patients responses transfer directly to the
electronic patient record
http://217.154.233.99/teleomedic2/resource/KCH/SCREENINGDEMO
IMPARTS – the wider context
CLINICAL PRACTICE
RESEARCH
POLICY
Improve detection &
management of
symptom distress
Routine collection of
patient-reported
outcomes
Identifying need &
informing resource
allocation
Inform clinical decisionmaking & promotes
timely intervention
Track change over time
Research database
Evidence generation
Transformation of
future care
Mental
health
services in
general
hospitals
Mental
health
training
for nonspecialists
The IMPARTS package
Informatics
• Routine
collection of
patientreported
outcomes
with advice
on care &
referral
Care
pathways
• Development
of mental
health care
pathways for
patients
identified via
screening
Training
Self-help
• Training in
mental health
skills with
ongoing
supervision
from a
mental health
specialist
• Portfolio of
bespoke selfhelp
materials,
tailored to
specific
physical
conditions
Implementation
Rheumatology
(KCH)
Limb
reconstruction
(KCH)
Hepatitis C
(KCH)
Sexual health
(KCH)
Breast cancer
(KCH)
Neurotrauma
(KCH)
Liver transplant
(KCH)
Neurocardiology
(KCH)
Pain services
(GSTT)
Obstetrics
(GSTT/KCH)
Congenital heart
disease (GSTT)
Dermatology
(GSTT)
Rheumatology
• Pain VAS
• Fatigue VAS
• Depression
PHQ-9
• Anxiety GAD-7
• Function HAQ
Limb
reconstruction
• Pain VAS
• Fatigue VAS
• Depression
PHQ-9
• Anxiety GAD-7
• Limb function LEF
• Alcohol & drugs
• Occupational
functioning
• Smoking
Hepatitis C
• Sleep (Jenkins)
• Anger
• Depression
PHQ-9
• Anxiety GAD-7
• Physical
symptoms
• Alcohol & drugs
• QoL WHODAS
• Adherence to
treatment
Acceptability of screening
Proportion of patients declining screening:
CLINIC
Pts approached
Pts declining
screening n (%)
Rheumatology
296
15 (5.1)
Limb reconstruction
177
7 (4.0)
Hepatitis C
31
1 (3.2)
Depression (PHQ-9)
CLINIC
Rheumatology
n=432
Limb Reconstruction Hepatitis C
n=169
n=26
Probable Major
Depression (MDD)
101 (23.4%)
36 (21.3%)
9 (34.6%)
Severe MDD with
suicidal ideation
14 (3.2%)
7 (4.1%)
2 (7.7%)
Severe MDD without 17 (3.9%)
suicidal ideation
6 (3.6%)
0
Moderate MDD
42 (9.7%)
17 (10.1%)
5 (19.2%)
Mild MDD
28 (6.5%)
6 (3.6%)
3 (11.5%)
Anxiety (GAD-7)
CLINIC
Rheumatology
n=432
Limb Reconstruction
n=169
Hepatitis C
n=26
Probable Generalised
Anxiety Disorder (GAD)
107 (24.8%)
33 (21.3%)
6 (23.0%)
Severe GAD
42 (9.7%)
20 (11.8%)
5 (19.2%)
Alcohol (AUDIT) & Drugs
CLINIC
Limb Reconstruction Hepatitis C
n=169
n=26
Probable Alcohol
Dependence
4 (2.4%)
0
Harmful drinking
0
1 (3.8%
Hazardous drinking
17 (10.1%)
1 (3.8%)
Probable Drug
Dependence
4 (2.4%)
3 (11.5%)
Post-traumatic Stress Disorder PTSD (PCL-4)
Limb Reconstruction (n=169)
Probable PTSD
10.4%
Some symptoms
22.0%
No problem
67.6%
IMPARTS Research Database
IMPARTS
screening data
EPR clinical &
demographic
data
IMPARTS
pseudonymised
Research Database
RESEARCHER
The database will
bring together
psychological &
physical health
outcomes into a
single, searchable,
anonymised data
repository.
Research opportunities (1)
Prevalence; Associations
Depression
Anxiety
PTSD
Drug &
alcohol
misuse
Physical
Health
symptoms
beliefs &
(e.g.fatigue, behaviours
pain);
e.g. nonBiomarkers adherence
Limb reconstruction, rheumatology, Hepatitis C…
Research opportunities (2)
Trajectories of depression,
anxiety, alcohol misuse in
different clinical
populations
Time 3
Time 2
Time 1
Research opportunities (3)
Outcomes of mental health problems in
physically ill populations over time…
Depression
•
•
•
Increased pain
Increased inflammation
Poorer adherence
Alcohol
dependence
•
•
•
Higher health costs
Increased unemployment
Higher mortality
Research opportunities (4)
Can we predict likelihood of non-remission?
- Less social support
- Unhelpful health beliefs
- Unemployed
- More pain
Depressed at
T1
Depressed at
T2
No depression
at T2
Consent for contact
• We have ethical approval to prospectively request consent for contact
via the IMPARTS screening interface
“I agree to be contacted by a researcher to offer me the
opportunity to take part in relevant research projects if they think
I may be a suitable participant”.
Yes
No
More information
• It would then be possible to deanonymise patient records to allow researchers
to contact potential trial participants –when explicit consent has been given
Teaching programmes
and self-help
materials
• Claire Doyle
• Katie Steel
• More on breathlessness and anxiety
later
• Example of Limb Reconstruction
service
Teaching programme
• Risk assessment and referral
• Managing anger
• Supporting adjustment
• Scheduling activity
• Increasing adherence
• Working with thought and
expectations
Self-help materials
• Learning to control your anger
• Are you on edge?
• Coping and living well
• Depression: are you struggling?
• Keeping active
• Getting on with your life after a
trauma
Other bespoke teaching programmes
• Respiratory ward
• Speech and language therapists
• Rheumatology nurses
Materials of general relevance
…and more specific
Emphasis on strengths
http://www.kcl.ac.uk/iop/depts/pm
/research/imparts/Ee-Self-helpmaterials.aspx
Join the IMPARTS mailing list
Subscribe at:
//mailman.kcl.ac.uk/mailman/listinfo/mentalphysicalhealthcareinterface
Email the group:
[email protected]
For more information on IMPARTS: [email protected]
IMPARTS module in Core Mental Health Skills





Delivered as part of Advanced Practice MSc module
Open to all non-mental health specialists interested in developing their skills
Special introductory offer £499
5 interactive taught days with e-learning component (Jan-Mar)
For more info contact: [email protected]
The depressed/
anxious patient
The agitated/
confused patient
Medically
unexplained
symptoms
The substance
misusing patient
Managing
conflict
Project Team
Prof Matthew Hotopf - Project Lead
Email: [email protected]
Dr Lauren Rayner - Project Coordinator
Email: [email protected]
Ms Faith Matcham – Research Assistant
Email: [email protected]
Dr Jane Hutton – Consultant Clinical
Psychologist
Email: [email protected]
Dr Rina Dutta – Consultant Psychiatrist
Email: [email protected]
Dr Katie Steel – Clinical Psychologist
Email: [email protected]