Transcript Hans Kordy

eHealth tools for the optimisation of
care for patients with mental disorders
Hans Kordy
Center for Psychotherapy Research, University of Heidelberg
3rd Ministerial European eHealth Conference and Exhibition, Tromsoe, Norway, 2005
eHealth at the Centre for Psychotherapy Research
•„Internet-Bridge“: maintenance group setting (Valiollah Golkaramnay,
Dipl.-Psych., Severin Haug, Dipl.-Psych.)
•„e-mail Bridge“: maintenance individual setting (Markus Wolf, Dipl.Psych.)
•„Relapse prevention through SMS-Monitoring“ (Stephanie Bauer, PhD)
•„Web-AKQUASI“: quality management & outcome monitoring (Robert
Percevic, PhD, Christine Gallas, Dipl.-Psych.)
Project “Internet-Bridge”
A collaborative enterprise of various stakeholders:
-Research: Forschungsstelle für Psychotherapie
-Clinical Provider: Panorama-Klinik Scheidegg/Allgäu
-Insurance/Payer: Techniker Krankenkasse
Project „Internet-Bridge“ - Background
Need for step-down maintenance programmes
Patients with mental disorders
- benefit substantially from inpatient care
- are at high risk to lose achieved gains
- wish to continue treatment
- are recommended to do so
- but, current service conditions make this difficult.
Project „Internet Bridge“
Strategy
- Maintenance approach / relapse prevention
- Group therapy in an Internet chat-room
- Outcome monitoring
Project „Internet Bridge“
Clinical concept - group setting
- 8–10 participants (disorder unspecific)
- open groups
- programme duration: 12-15 weekly sessions
- session duration: 90 min.
- groups are guided by experienced group therapists
Project „Internet Bridge“- Connecting people
Participants
Hospital / Therapists
Center for PT Research / Server
Project „Internet Bridge“
Technical background
- Server
- Software
- Technical administration and support
- Homepage
- Training of therapists and patients
Project „Internet Bridge“
Security and confidentiality
- Chat-room:
password-protected
- Online questionnaires:
password-protected
- Passwords:
changing regularly
- Communication:
pseudonyms
- Data transfer:
encoded (SSL)
- Server:
firewall
Project „Internet Bridge“
Continuous monitoring
- Software: Web-Akquasi
- Pre-session questionnaires
-
Post-session questionnaires
(current impairment / symptoms)
(session evaluation items / satisfaction)
Project „Internet Bridge“
- Outcome Monitoring
ContinuousAKQUASI
monitoring
- Software: Web-Akquasi
therapyon symptom status and change
- continue
Feedback
(predominantly improvements)
Scale
Psychological distress
Physical impairment
Interpersonal impairment
Social impairment
Coping Resources
General life satisfaction
State
Change Last Change
Legal aspects
Principle: avoid negligence!
- data protection and privacy
- professional standards / code of professional conduct
- liability law
- criminal law
Emergency measures
- face-to-face diagnosis at beginning
- Hospital emergency service (24 hours)
- Therapist’s telephone – 90 min after session
- Check of health/mood status at logout
- Local emergency contact (e.g. primary carer)
Project „Internet Bridge“ – The Study
Aims
- Feasibility & Reliability
- Acceptance
- Effectiveness
Project „Internet Bridge“
Design
12-15 weekly
chat sessions
inpatient treatment
Chat
group
admission
discharge
6-months
follow-up
12-months
follow-up
inpatient treatment
Control
group
admission
discharge
6-months
follow-up
12-months
follow-up
Project „Internet Bridge“
Sample
- treatment group:
N = 117 patients
- control group:
N = 117 patients
- inpatient treatment
- stability at discharge from hospital
- internet access
- experienced group therapists:
. familiar with specific problems of the patients
. familiar with PC and chat
Project „Internet Bridge“ – Study design
Sample - diagnosis
F3
F6
F4
F5
0,0
10,0
20,0
30,0
Chatgr
Verglgr
40,0
50,0
60,0
Project „Internet Bridge“ – Study results
Acceptance
- Interest for the offer
80%
- Drop-out rate
13%
- Session attendance
87%
- Satisfaction with sessions
90%
- Satisfaction with programme
85%
Project „Internet Bridge“ – Study results
Evaluation of the setting
- Session duration
74%
- Weekly sessions
80%
- Programme duration
55%
- Importance of the therapist
80%
- Importance of anonymity
38%
- Willingness to pay (privately)
51%
Project „Internet Bridge“ – Study results
Effectiveness – main criterion: stability of therapeutic gains
discharge
11,8
14,3
6 months fu
34,6
22,1
38,70
12 months fu
25
0
10
20
control
chat
30
40
50
Project „Internet Bridge“ – Study results
Effectiveness – Psychological distress (SCL-90-R)
1,2
1
0,8
0,6
0,4
0,2
0
admission
discharge
6-months
12-months
Chat
Control
Project „Internet Bridge“ – Study results
Effectiveness – Physical impairment (GBB)
35
30
25
20
15
10
5
0
admission
discharge
6-months
12-months
Chat
Control
Project „Internet Bridge“ - Conclusions
Chat-groups....
....proved technically feasible
....are well accepted by patients
....promise effective relapse prevention
eHealth - Outlook
E-Health tools such as internet chat-groups contribute to
the optimisation of care through....
....facilitating access (bridges geografical and
psychosocial distances)
....extending the reach of specialists
....increasing the flexibility of care and carers
....improving the match between patients needs
and provided care
Invitation
For further questions:
[email protected]
[email protected]