Health providers’ experiences with mental health specialist video consultations in primary care: a qualitative study nested within a randomised feasibility trial

ObjectiveDespite available effective treatments for mental health disorders, few patients in need receive even the most basic care. Integrated telepsychiatry services may be a viable option to increase access to mental healthcare. The aim of this qualitative process evaluation embedded in a randomised controlled feasibility trial was to explore health providers’ experiences with a mental healthcare model integrating mental health specialist video consultations (MHSVC) and primary care.MethodsA qualitative process evaluation focusing on MHSVC in primary care was conducted. In 13 semistructured interviews, we assessed the experience of all mental health specialists, primary care physicians and medical assistants who participated in the trial. A thematic analysis, focusing on the implementation, mechanisms of impact and context, was applied to investigate the data.ResultsConsidering (1) the implementation, participants evaluated the consultations as feasible, easy to use and time saving. Concerning (2) the mechanisms of impact, the consultations were regarded as effective for patients. Providers attributed the patients’ improvements to two key aspects: the familiarity of the primary care practice and the fast access to specialist mental healthcare. Mental health specialists observed trustful therapeutic alliances emerging and described their experience as comparable to same-room care. However, compared with same-room care, specialists perceived the video consultations as more challenging and sometimes more exhausting due to the additional effort required for establishing therapeutic alliances. Regarding (3) the intervention’s context, shorter travel distances for patients positively affected the implementation, while technical failures, that is, poor Internet connectivity, emerged as the main barrier.ConclusionsMHSVCs in primary care are feasible and successful in improving access to mental healthcare for patients. To optimise engagement and comfort of both patients and health providers, future work should focus on empirical determinants for establishing robust therapeutic alliances with patients receiving MHSVC (eg, leveraging non-verbal cues for therapeutic purposes).Trial registration numberDRKS00015812; Results.

THE DESCRIPTION OF EXCLUSIVE BREASTFEEDING AS LACTATION AMENORRHEA METHOD CONTRACEPTION)

Background: Exclusive breastfeeding has benefits as a natural contraceptive method, the Lactational Amenorrhea Method (LAM). The coverage of exclusive breastfeeding in East Java Province in 2018 only reached 74.3% and coverage of active family planning was still at 75.3% (Health Office of East Java, 2018). The results of a preliminary study of 10 Children’s Health Specialist Doctor Education Program of Airlangga University showed exclusive breastfeeding, but only 20% managed to menstruate for more than 6 months. This study aims to determine the description of exclusive breastfeeding as LAM at Dr Soetomo Hospital Surabaya. Method: This type of research uses a descriptive method to mix method research with survey analytic methods. The number of samples used was 16 people with simple random sampling technique. Results: PPDS who got LAM success during exclusive breastfeeding, by giving on demand and frequency more than 8 times was only 37.5%, while the remaining 62.5% PPDS failed to achieve LAM. The inhibiting factors are not being able to give immediately, time for pumping, and inadequate rest. The support received by PPDS is tolerance for pumping, high determination of exclusive breastfeeding, and family support. How to give breast milk is to breastfeed directly and by bottle. The reason for using the bottle is to work. The number of PPDS with amenorrhea duration 1-3 months was 7 people, and only 1 PPDS experienced amenorrhea for 12 months. Conclusion: Nearly half of PPDS have successfully used LAM as a contraceptive.

DISCOURSE ON PROFESSIONALISATION IN THE PRACTICE OF PUBLIC HEALTH PROFESSIONALS PROVIDING SERVICES TO PERSONS WITH DISABILITIES

This article is aimed to discuss findings of the study on professionalisation in the practice of public health professionals who provide services to persons of all ages with disabilities. The following problematic questions are raised: how does a public health specialist become a professional competent in providing their services to all citizens, regardless of age or health status? What are the possible professionalisation ways and opportunities for public health professionals who provide services to persons of different age with disabilities? The article presents a theoretical discourse of the professionalisation process, as well as results of the qualitative research so as to provide insight into possible ways (opportunities) for professionalisation of public health professionals in providing services to persons of different ages with disabilities. The study is novel in that it discloses dimensions (professionalism and professionism) of a public health specialist’s professionalisation process in working with persons of different ages with disabilities. As findings of the study show, the dimensions are theoretically inseparable from each other, though, with quite different ways of professionalisation in practice. The study has established that the ways of professionalisation (1.Work-based learning; 2.Reflection and activities; 3.Reflection on activities (formalisation of unexpressed competencies); 4.Reflection for activities; 5.Organisational culture and activities; 6.Integration/assimilation of knowledge) enable a person to develop existing competencies, to construct a professional identity through the integration of both aspects of relevance of professionalisation ways: practical activities and reflection.

Low-Intensity Interventions and EMDR Therapy

Unlike high intensity treatment, in which clients have face-to-face contact with a mental health specialist, clients in low-intensity treatment have limited or no contact with a specialist. Instead, their treatment is usually provided through self-help procedures, which are delivered via (guided) computer programs, books, or mHealth apps. Other treatments sometimes considered low intensity are brief treatments, group therapy, and interventions delivered by nonspecialists. Advantages include effectiveness, accessibility, efficiency, and affordability. Concerns related to safety, engagement, and adherence in self-help programs may be addressed by (asynchronous) therapist guidance. This article describes low-intensity treatments, and their relevance for eye movement desensitization and reprocessing (EMDR) therapy. Hundreds of randomized controlled trials (RCTs) have found self-help interventions to be efficacious, with many producing the same level of results as the traditional face-to-face procedure. Guided self-help cognitive behavioral therapy is recommended for the treatment of posttraumatic stress disorder in the guidelines of both the National Institute for Health and Care Excellence and International Society of Traumatic Stress Studies. Only three self-help-EMDR RCTs have been conducted. This author advocates for reconceptualizing EMDR group therapy as “guided EMDR-self-help therapy,” because it is a highly manualized, heavily scripted treatment, in which the client works independently on their own material. In this respect, it offers an excellent template for the future development of efficacious low-intensity EMDR interventions. Developing safe, easy-to-use, affordable, and readily available low-intensity interventions will make effective EMDR treatment available to many millions of people around the world.

Mental health specialist video consultations versus treatment as usual in patients with depression or anxiety disorders in primary care: study protocol for an individually randomised superiority trial (the PROVIDE-C trial)

Background: The majority of people with mental disorders, including those with severe and chronic disorders, are treated solely by their general practitioner (GP). Nevertheless, specialised mental health care may be required for specific patients. Notably, the accessibility of mental health specialist care is mainly complicated by (a) long waiting times for an appointment with specialists, (b) long travel distances to specialists, particularly in rural and remote areas and (c) patients’ reservations about mental health specialist care (including fear of being stigmatised by seeking such care). To mitigate those barriers, technology-based integrated care models have been proposed. The purpose of this study is to examine the effectiveness and cost-effectiveness of a mental health specialist video consultations model versus treatment as usual in patients with depression or anxiety disorders in primary care. Methods: In an individually randomised, prospective, two-arm superiority trial with parallel group design, N = 320 patients with anxiety and/or depressive disorder will be recruited in general practices. The intervention includes a newly developed treatment model based on video consultations with focus on diagnostics, treatment planning, and short-term intervention by mental health specialists. We will systematically compare the effectiveness, cost-effectiveness, and adverse effects of this new model with usual care by the GP: The primary outcome is the absolute change in the mean depressive and anxiety symptom severity measured on the Patient Health Questionnaire Anxiety and Depression Scale (PHQ-ADS) from baseline to 6 months after baseline assessment. Follow-up in both groups will be conducted by blinded outcome assessors at 6 months and 12 months after baseline. The main analysis will be based on the intention-to-treat principle. We will optimise the likelihood of treatment effectiveness by strict inclusion criteria for patients, enhanced intervention integrity, and conducting a process evaluation. Discussion: To the best of our knowledge, this is the first confirmatory study on a video-based, integrated care model for the treatment of anxiety and depressive disorders in GP patients in Germany. Trial registration: ClinicalTrials.gov, United States National Institutes of Health (NCT04316572, https://clinicaltrials.gov/ct2/show/NCT04316572). Prospectively registered on 20 March 2020.