Examples of emental health implementation Aragón Healthcare Service (SALUD), Spain

Transcription

1 Examples of emental health implementation Aragón Healthcare Service (SALUD), Spain Modesto Sierra Callau Sector Sanitario de Barbastro, Servicio Aragonés de SALUD EIPonAHA B3 Action Group Webinar 1

2 Aragón Baseline in Sector Sanitario de Barbastro High workload of mental health professionals, frequent changes of staff, young and motivated professionals Long waiting list for mental health resources No previous experiences in e-mental health Culture of innovation and experience on e-health Patient with depression ccvc ccbt ccbt ccbt

3 Technical Support Mental Health Unit Contact Center Primary Care Patient The road to implementation: Patient QoL Professionals satisfaction Quality of service Sustainability Project Definition Execution Assessment Implementation MAST

4 MasterMind. Pilot Definition (and evolution!) Mastermind Generic Protocol Spanish Cluster Supera Tool Common protocol Lessons learnt from 1st wavers Changes on local protocol Institution Objectives and resources

5 MasterMind. Project Execution Target : 100 patients 2nd wave Service ccbt ccvc Dates Oct > ongoing Jan > ongoing Area of coverage Sector Sanitario Barbastro Lafortunada Healthcare Area Recruitment / Follow up Professionals involved Technological developments Patients included (11th May 2017) Primary Care/ Mental Health Unit 3 psychiatrists 2 psychologist 5 nurses 7 GPs - Screening Tests (Intranet) - Tool Supera Tu depresión (Spanish Cluster) Primary Care <-> Mental Health Unit 4 psychiatrists 3 GPs 1 nurse - Selection of patients for sessions - Interchange of information during sessions Technical Support Mental Health Unit Contact Center Primary Care Patient

6 MasterMind (ccbt). Project Execution Module 1 Module 2 Module 3 Module 4 Module 5 Module 6 Module 7 Module 8 What is depression? How different activities affect our mood? Increasing pleasant activities How thoughts affect our mood Learning to change our negative thoughts Learning to change our negative thoughts: Increasing social Activities Looking at the future negative situations Each module includes Text Content Video content Activities Forms Auxiliary Module Healthy Habits 8 modules (+ 1 extra) to be completed sequentially One module per week (8 weeks the whole programme) Follow-up Daily mood record Questionnaires after modules 2, 4, 6, 8

7 MasterMind (ccbt). Project Execution Inclusion Criteria Inclusion >= 18 years, depression, use of mobile Exclusion: comorbidities, risk of autolysis Initial Assessment Informed Consent Training session Follow-up Final Evaluation Generate confidence with the online tool Questionnaires, first approach Strenght commitment Through platform and through . Alarms. Validation and call to other profiles Weak (low adherence, low activity) Severe (severe worsening, perception of dangerous situation) Through telephone Positive feedback Assessment of clinical evolution & patient opinion.

8 MasterMind (ccvc). Project Execution Where: Between main hospital (Barbastro) and rural area (Lafortunada) Who: Primary Care and Mental Healthcare Unit What: Collaborative work with the help of VC system and new ICT tools When: Jan > Now Why: To reduce consultations in MHU, to increase information about patients, to reduce travels, to improve care quality UCSM Mental Health Collaborative Unit

9 MasterMind. Project Assessment MASTERMIND MAST. Common evaluation Local evaluation add-ons Clinical outcomes Added value Focus on lessons learnt After MASTERMIND MAFEIP Analysis of results Assessment of new scenarios Organisa tional Aspects Socioethical and legal Economic Aspects Health problem Patient and Professional Patient Safety Clinical Efective ness

10 QOL/MH DEPRESION QOL/ MH DEPRESSION QOL/ MH DEPRESION MasterMind(ccBT). Project Assessment. Clinical outcomes 33% in module 8 52% in module 2 48% in module 4 8,27% did not reach 8 but no symptoms in last control 41, 35% Reached module 8 or reached at least module 5 and did not show symptoms during the last control Patients in module Session 0 Session 2 Session 4 Patients in module Patients in module Session 0 Session 2 Session 4 Session 6 Session Session 0 Session 2 Session 4 Session 6 0,62 alarms per patient (triggered by result on questionnaire that showed severe depression and /or risk of autolysis

11 MasterMind(ccVC). Project results Since Jan Patients / session patients 219 consultations 23 sessions 0 admissions in the acute mental health unit Less consultations Early detection of symptoms 0

12 Assessment: focus on initial goals Quality of service Effectiveness of ccbt treatment is similar to F2F treatment. Symptoms reduction for patients who follow more than 50% of treatment Added value. Better knowledge about patients (ccbt questionnaires at home and alarms generation, ccvc info from patient environment) ccbt and ccvc help to adapt frequentation (subjective -> objective) ccvc -> No admissions to Long Stay Unit in the area of coverage since MasterMind started Service sustainability ccbt can be implemented for treatment of depression both in Primary Care and in Specialized Care (Mental Health Unit) ccbt : Follow up can be performed by nurses (transfer of tasks) ccvc allow the follow up of some patients at Primary Care From subjective frequentation -> objective frequentation thanks to up to date information from patient and additional support Patient QoL Patients perceive additional support, quality of service and evaluate the service positively Professionals Professionals perceive the quality of the service ccbt and ccvc tool provides up to date, additional and relevant information from patient Professionals receive positive feedback from patients

13 Mastermind Assessment: Focus on implementation Adherence Initial training impacts on adherence Patients do not give second chances Holiday periods have a negative impact on adherence Age is not a barrier (elders perform ccbt well) Implementation Protocol should be flexible to deal with specific issues (lack of adherence, detection of potential risks, auto-referral) Release from bureaucracy GPs and Clinicians Technology is good enough and users are able to use it. But Technical support is needed This kind of tools can be helpful for other mental health profiles ccbt is not free, investment on resources is necessary Evaluate in detail the workload for all the profiles (e.g. contact center, alarms, messages received, technical incidences, )

14 ccbt Evaluation of impact: MAFEIP Health states transition Costs Utitily (HRQoL) Resources IMPACT Age-related incremental value Cost-effectiveness Cumulative utility Transitions between health states Health

15 ccbt Evaluation of impact: MAFEIP Model 3 states transition Costs Utility (HRQoL) Clinical Evolution Deteriorated state: person with depression Intervention costs Generic costs: ICT, development and training For each patient: Time for training, follow-up, problems resolution, alarms management, evaluation Healthcare resources Societal costs Questionnaire: prepost (likert scale 7 values)

16 ccbt Evaluation of impact MAFEIP Evolution of impact / Age Higher positive economic impact with younger people Effectiveness has a tendency to decrease as age increases In any case the effectiveness is positive and there is reduction of costs Service sustainability Comparison between costs and health effects. Intervention is dominant (cost-effective) (cheaper and better) Impact in time Intervention has immediate effect. Impact increases in the medium term and is stable in the long term

17 From Mastermind to Practice Maintenance of original scenarios Services continue in those scenarios where the pilot took place Services had to be adapted to deal with resources included in the project (e.g. contact center nurse, training videos instead of training sessions) Internal dissemination and presentation of results Presentations to professionals and to management New analysis of results when required Show clear evidences Definition of the universal services and set up at different locations Differences between Urban / Medium-size/ rural Mental Health / Primary Care / Local Cabinets New ideas based on results Group sessions with SUPERA (MasterMind) videos Need for continuous update (this is not the end ) Materials might get old-fashioned in 3/5years Platform should be updated continuously to look more attractive Adaptation to GDPR Adaptation to new EHR Aragón

18 Mastermind en SALUD- Sector Sanitario de Barbastro Unidad de Salud Mental Barbastro Bárbara Moles María José Val María Teresa Mora Marisa González Unidad de Salud Mental Monzón: Eduardo Kawamura Miguel Domper Rosa López Atención Primaria Mónica Pascual (Tamarite/Albelda) Jose María Leris (Monzón Rural) Olga Ordás (Monzón Rural) Dolores Muñoz (Binéfar) Carmen Alastrue (Monzón Rural) Rosa Puértolas (Barbastro Rural) Unidad de Innovación Dionisia Romero Enfermera Centro de Contacto Modesto Sierra / Rosana Anglés Técnicos de Innovación msierrac@salud.aragon.es /ranglesb@salud.aragon.es Juan I. Coll Clavero Responsable Innovación y Nuevas Tecnologías jcoll@salud.aragon.es Sector Sanitario de Barbastro Hospital de Barbastro Ctra. Nacional 240 s/n, Barbastro, Spain Tel: Innovation.hbrb@salud.aragon.es