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Introducing IMPARTS:
Integrating Mental & Physical healthcare:
Research Training & Services
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 Project Overview
 Aim:
To improve the mental healthcare of patients presenting in physical healthcare
settings
 Objectives:
1. To map mental health-related services provided by KHP’s acute trusts
2. To design and deliver training on mental health issues to non-specialists
3. To develop informatics to improve detection and management common
mental disorders in medical settings
1) Mapping Project
KHP’s acute trusts
Mental health-related services
•
•
•
•
• Psychiatry
• Psychology
• Counselling
King’s College Hospital
Guy’s Hospital
St Thomas’
Lewisham & Croydon
MAPPING
PROJECT
Generic services..
Disease-specific services..
•
•
•
•
• Respiratory, cardiology, cancer,
epilepsy, Huntingdon disease,
diabetes, liver, rheumatology,
perinatal, HIV, Parkinson’s
disease, dermatology etc
A&E
outpatient liaison
inpatient liaison
paediatric liaison
2) Masters module in Psychological Medicine
 To be offered by KCL’s Advanced Nursing Masters courses from 2013
 One week taught course with web-based interaction:
The depressed/
anxious patient
The agitated/
confused patient
Medically
unexplained
symptoms
The substance
misusing patient
Managing
conflict
3) IMPARTS informatics screening system
To use informatics systems to screen medical patients for
CMD and other symptoms whilst they wait for their
outpatient appointment, making the results immediately
available to the clinician prior to consultation, and
flagging up any issues that should be addressed.
IMPARTS informatics system
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
Integrative
Scalable
Flexible
IMPARTS
informatics
system
Sustainable
Iterative
Rheumatology pilot
Objectives
1. To determine whether informatics screening is feasible in a busy clinic
setting
2.
To determine whether informatics screening is acceptable to patients
and staff
3.
To determine the rate of common mental disorder in a rheumatology
clinic setting
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Procedure:
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1. Patients arriving for appointment are
given information sheet explaining purpose of
screening
2. Patients log on to a laptop/ e-tablet in the
waiting room, using their Hospital ID and
initials
3. Patients select their diagnosis and
complete a series of short questionnaires
tailored to their condition
4. Patients scores transfer directly to the
EPR/ specialty database
http://217.154.233.99/teleomedic2/resource/KCH/SCREENINGDEMO
Feasibility
Pts on clinic list
n=288
Pts attending appt.
n=210
Pts not screened
22 (10%)
Reasons not screened:
Pt declined 8 (3.8)
IT problem 7 (3.3)
No English 3 (1.4)
No time 2 (1.0)
Disability 1 (0.5)
Incomplete 1 (0.5)
Pts screened n=188
(90%)
Screening
encounters n=269
Challenges
Embedding in clinical
practice
IT barriers
Core mental health
skills for clinical teams
Meeting demand
Referral pathway
Suicidal ideation AND severe
depression (PHQ-9 score=20-27)
Suicidal ideation OR severe
depression (PHQ-9 score=20-27)
Mild to moderately severe
depression (PHQ-9=<19) WITH
complex interaction with medical
problem
Mild to moderately severe
depression (PHQ-9=<19)
WITHOUT complex interaction with
medical problem
• Urgent referral to liaison
psychiatry
• Referral to liaison psychiatry
• Referral to clinical psychology
• Referral to IAPT
Bespoke self-help portfolios for specific LTCs
Rheumatology
Depression
Anxiety
Sleep
hygiene
Pain
management
Activity
scheduling
Orthopaedics
Depression
Anxiety
Alcohol
Problemsolving
Stress
The IMPARTS package
Informatics
Training
Supervision
Self-help
• Routine
collection of
patientreported
outcomes
with advice
on care &
referral
• Training in
mental health
skills…
(managing
distress,
appropriate
referral,
problemsolving)
• Ongoing
supervision &
support of
clinic staff by
mental health
specialist
• Portfolio of
bespoke selfhelp
materials,
tailored to
specific longterm
conditions
Research opportunities
IMPARTS
screening data
EPR clinical &
demographic
data
IMPARTS
pseudonomysed
Research Database
RESEARCHER
•
Patterns of mental disorder,
symptoms, disability & health
behaviour
•
Associations between symptoms,
function, QoL & demographic &
clinical variables
•
Predictors of good and poor
outcomes
•
Comparative effectiveness studies
•
Pathways through care
Recruitment into trials
• We are seeking ethical approval to prospectively request consent for contact
via the IMPARTS screening interface
“Would you be happy for a researcher to contact you if your
responses suggest that you might be suitable for a research
project currently taking place at the hospital?”
• It would then be possible to deanonymise patient records to allow researchers
to contact potential trial participants –when explicit consent has been given
Long-term view:
Routine data
collection
Generating new
hypotheses for
investigation
Research
database
Evaluating
outcome of
change in
practice
Trial
recruitment
Implementing
evidence in
clinical care
Data analysis
& evidence
generation
Prof Matthew Hotopf
Project Lead
Email: [email protected]
Dr Lauren Rayner
Project Coordinator
Email: [email protected]