卫生保健提供者在初级保健中使用心理健康专家视频咨询的体验：一项嵌套在随机可行性试验中的定性研究。

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

机构信息

Department of General Internal Medicine and Psychosomatics, Heidelberg University, Heidelberg, Baden-Württemberg, Germany

Department of General Internal Medicine and Psychosomatics, Heidelberg University, Heidelberg, Baden-Württemberg, Germany.

出版信息

BMJ Open. 2021 Nov 9;11(11):e047829. doi: 10.1136/bmjopen-2020-047829.

DOI:10.1136/bmjopen-2020-047829

PMID:34753752

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8578962/

Abstract

OBJECTIVE

Despite 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.

METHODS

A 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.

RESULTS

Considering (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.

CONCLUSIONS

MHSVCs 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 NUMBER

DRKS00015812; Results.

摘要

目的

尽管有针对心理健康障碍的有效治疗方法，但很少有需要的患者得到最基本的治疗。综合远程精神病学服务可能是增加获得精神卫生保健机会的可行选择。这项随机对照可行性试验中嵌入的定性过程评估旨在探索卫生保健提供者对整合精神健康专家视频咨询（MHSVC）和初级保健的精神保健模式的体验。

方法

对初级保健中的 MHSVC 进行了定性过程评估。在 13 次半结构化访谈中，我们评估了参与试验的所有精神健康专家、初级保健医生和医疗助理的经验。采用以实施、影响机制和背景为重点的主题分析来调查数据。

结果

考虑到（1）实施情况，参与者评估咨询具有可行性、易于使用且节省时间。关于（2）影响机制，咨询被认为对患者有效。提供者将患者的改善归因于两个关键方面：初级保健实践的熟悉程度和快速获得专家精神保健的机会。精神健康专家观察到信任的治疗联盟正在形成，并将他们的经验描述为与同室护理相当。然而，与同室护理相比，专家认为视频咨询更具挑战性，有时因建立治疗联盟所需的额外努力而更具挑战性。关于（3）干预背景，患者的旅行距离较短对实施产生了积极影响，而技术故障（即互联网连接不良）是主要障碍。