Hoffmann Mariell, Hartmann Mechthild, Wensing Michel, Friederich Hans-Christoph, Haun Markus W
Department of General Internal Medicine and Psychosomatics, Heidelberg University, Heidelberg, Germany.
Department of General Practice and Health Services Research, Heidelberg University, Heidelberg, Germany.
J Med Internet Res. 2019 Aug 19;21(8):e13382. doi: 10.2196/13382.
Although real-time mental health specialist video consultations have been proposed as an effective care model for treating patients with mental health conditions in primary care, little is known about their integration into routine practice from the perspective of family physicians.
This study aimed to determine the degree to which family physicians advocate that mental health specialist video consultations can be integrated into routine primary care, where most patients with mental health conditions receive treatment.
In a cross-sectional qualitative study, we conducted 4 semistructured focus groups and 3 telephonic interviews in a sample of 19 family physicians from urban and rural districts. We conducted a qualitative content analysis applying the Tailored Implementation in Chronic Diseases framework in a combined bottom-up (data-driven) and top-down strategy for deriving key domains.
Family physicians indicated that mental health specialist video consultations are a promising and practical way to address the most pressing challenges in current practice, that is, to increase the accessibility and co-ordination of specialized care. Individual health professional factors were the most frequently discussed topics. Specifically, family physicians valued the anticipated clinical outcomes for patients and the anticipated resources set for the primary care practice as major facilitators (16/19, 84%). However, family physicians raised a concern regarding a lack of facial expressions and physical interaction (19/19, 100%), especially in emergency situations. Therefore, most family physicians considered a viable emergency plan for mental health specialist video consultations that clearly delineates the responsibilities and tasks of both family physicians and mental health specialists to be essential (11/19, 58%). Social, political, and legal factors, as well as guideline factors, were hardly discussed as prerequisites for individual family physicians to integrate mental health specialist video consultations into routine care. To facilitate the implementation of future mental health specialist video consultation models, we compiled a checklist of recommendations that covers (1) buy-in from practices (eg, emphasizing logistical and psychological relief for the practice), (2) the engagement of patients (eg, establishing a trusted patient-provider relationship), (3) the setup and conduct of consultations (eg, reliable emergency plans), and (4) the fostering of collaboration between family physicians and mental health specialists (eg, kick-off meetings to build trust).
By leveraging the primary care practice as a familiar environment for patients, mental health specialist video consultations provide timely specialist support and potentially lead to benefits for patients and more efficient processes of care. Integration should account for the determinants of practice as described by the family physicians.
German Clinical Trials Register DRKS00012487; https://www.drks.de/drks_web/navigate.do? navigationId=trial.HTML&TRIAL_ID=DRKS00012487.
尽管实时心理健康专家视频会诊已被提议作为一种在初级保健中治疗心理健康问题患者的有效护理模式，但从家庭医生的角度来看，对于将其整合到常规实践中的情况知之甚少。
本研究旨在确定家庭医生主张将心理健康专家视频会诊整合到常规初级保健中的程度，而大多数心理健康问题患者在初级保健中接受治疗。
在一项横断面定性研究中，我们对来自城市和农村地区的19名家庭医生样本进行了4次半结构化焦点小组讨论和3次电话访谈。我们采用自下而上（数据驱动）和自上而下相结合的策略，应用慢性病定制实施框架进行定性内容分析，以得出关键领域。
家庭医生表示，心理健康专家视频会诊是应对当前实践中最紧迫挑战的一种有前景且实用的方式，即提高专科护理的可及性和协调性。个体卫生专业人员因素是讨论最频繁的话题。具体而言，家庭医生认为对患者预期的临床结果以及为初级保健实践设定的预期资源是主要促进因素（19人中有16人，占84%）。然而，家庭医生对缺乏面部表情和身体互动表示担忧（19人中有19人，占100%），尤其是在紧急情况下。因此，大多数家庭医生认为为心理健康专家视频会诊制定一个可行的应急计划至关重要，该计划应明确界定家庭医生和心理健康专家的职责和任务（19人中有11人，占58%）。社会、政治和法律因素以及指南因素，几乎没有被作为个体家庭医生将心理健康专家视频会诊整合到常规护理中的先决条件进行讨论。为了促进未来心理健康专家视频会诊模式的实施，我们编制了一份建议清单，涵盖（1）医疗机构的支持（例如，强调对医疗机构的后勤和心理缓解），（2）患者的参与（例如，建立可信赖的医患关系），（3）会诊的设置和进行（例如，可靠的应急计划），以及（4）促进家庭医生和心理健康专家之间的合作（例如，启动会议以建立信任）。
通过将初级保健实践作为患者熟悉的环境，心理健康专家视频会诊提供了及时的专科支持，并可能为患者带来益处，使护理过程更高效。整合应考虑家庭医生所描述的实践决定因素。
德国临床试验注册中心DRKS00012487；https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00012487 。
