Mathiasen Kim, Holmberg Sainte-Marie Trine Theresa, Skaarnes Helene, Jensen Esben Kjems, Vis Christiaan, Tarp Kristine
Research Unit for Digital Psychiatry, Centre for Digital Psychiatry, Mental Health Services of Southern Denmark, Odense, Denmark.
Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense C, Denmark.
Front Digit Health. 2023 Jul 12;5:1128893. doi: 10.3389/fdgth.2023.1128893. eCollection 2023.
The ItFits implementation toolkit was developed as part of the ImpleMentAll EU Project, to help guide implementation processes. The ItFits toolkit was tested in the online clinic, Internetpsykiatrien, in the Region of Southern Denmark, where it was employed to optimize screening and intake procedures. We hypothesized that a larger proportion of assessed patients would be referred to treatment. Further, we hypothesized the completion rate and effectiveness would increase, as a result of including a more relevant sample.
Using the ItFits-toolkit, Internetpsykiatrien developed a revised online screening tool. Data on patient flow and symptom questionnaires was extracted from Internetpsykiatrien six months prior to- and six months after implementation of the revised online screening tool.
A total of 1,830 applicants self-referred for treatment during the study period. A significantly lower proportion of patients were referred to treatment after implementation of the revised screening tool (pre-implementation, = 1,009; post-implementation, = 821; odds ratio 0.67, 95% CI: 0.51; 0.87). The number of patients that completed treatment increased significantly (pre-implementation: 136/275 [49.45%], post-implementation, = 102/162 [62.96%]; odds ratio 1.79, 95% CI 1.20; 2.70). The treatment effect was unchanged ( = 0.01, = .996). Worth noting, the number of patients that canceled their appointment for the video assessment interview decreased drastically.
By using the ItFits toolkit for a focused and structured implementation effort, the clinic was able to improve the completion rate, which is an important effect in iCBT. However, contrary to our hypotheses, we did not find an increase in clinical effect, nor a larger ratio being referred to treatment after assessment. The decreased number of referrals for treatment could be a result of increased awareness of inclusion criteria among the clinicians.
ItFits实施工具包是作为“全面实施欧盟项目”的一部分而开发的，旨在帮助指导实施过程。ItFits工具包在丹麦南部地区的在线诊所Internetpsykiatrien进行了测试，该诊所使用它来优化筛查和接诊程序。我们假设接受评估的患者中会有更大比例被转诊接受治疗。此外，我们假设由于纳入了更具相关性的样本，完成率和有效性将会提高。
Internetpsykiatrien使用ItFits工具包开发了一种修订后的在线筛查工具。在修订后的在线筛查工具实施前六个月和实施后六个月，从Internetpsykiatrien提取了患者流量和症状问卷的数据。
在研究期间，共有1830名申请人自行转诊接受治疗。实施修订后的筛查工具后，被转诊接受治疗的患者比例显著降低（实施前，=1009；实施后，=821；优势比0.67，95%置信区间：0.51；0.87）。完成治疗的患者数量显著增加（实施前：136/275[49.45%]，实施后，=102/162[62.96%]；优势比1.79，95%置信区间1.20；2.70）。治疗效果没有变化（=0.01，=0.996）。值得注意的是，取消视频评估访谈预约的患者数量大幅减少。
通过使用ItFits工具包进行有针对性的结构化实施工作，该诊所能够提高完成率，这在互联网认知行为疗法（iCBT）中是一个重要成果。然而，与我们的假设相反，我们没有发现临床效果增加，也没有发现评估后被转诊接受治疗的比例更高。治疗转诊数量的减少可能是由于临床医生对纳入标准的认识提高所致。
