Download The IMPARTS screening project: Informatics for managing common IMPARTS Project Overview

IMPARTS Project Overview
• Aim:
The IMPARTS screening project:
Informatics for managing common
mental disorder in medical settings
IMPARTS: Integrating Mental and Physical
healthcare: Research Training and Services
To improve the mental healthcare of patients presenting in physical
healthcare settings
• Objectives:
1. To map mental health-related services provided by KHP’s acute trusts
2. To design and deliver training on mental health issues to nonspecialists
3. To develop informatics to improve detection and management
common mental disorders in medical settings
Rationale
Aim
• Depression & anxiety are common in physically ill people & associated
with negative outcomes (e.g. pain, fatigue, poor prognosis)
• It is worth detecting CMD in physically ill people because they can be
effectively treated using pharmacological (Rayner 2010) &
psychological approaches (Beltman 2010).
•
NICE guidelines stipulate that people with a chronic health problem
should be routinely screened for depression to improve detection
(NICE 2009)
•
Screening should be accompanied by a management plan to provide
care and follow-up to patients with probable mental disorder (clear
referral pathways; regular reassessment) (NICE 2009)
Routine electronic symptom screening
CLINICAL PRACTICE
RESEARCH
POLICY
Improve
identification &
assessment of
symptom distress
Inform clinical
decision-making &
promotes timely
intervention
Large-scale
research databases
Identifying need &
informing resource
allocation
Track change over
time
Data aggregation &
analysis
Evidence
generation
Transformation of
future care
Mental
health
services
in
general
hospitals
Mental
health
training
for nonspecialis
ts
To use informatics systems to screen medical
patients for CMD and other symptoms whilst they
wait for their outpatient appointment, making the
results immediately available to the clinician prior
to consultation, and flagging up any issues that
should be addressed.
Rheumatology pilot
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Procedure:
Objectives
1. To determine whether informatics screening is feasible in a
busy clinic
setting
2. To determine whether informatics screening is acceptable to
patients and staff
3. To determine the rate of common mental disorder in a
rheumatology clinic setting
http://217.154.233.99/teleomedic2/resource/KCH/SCREENINGDEMO
Feasibility
Usability
Of the 188 patients screened, 82 (43%) needed some
assistance with completing the questionnaires
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Rheumatology pilot: Implications
•
There is a high rate of psychiatric morbidity in rheumatology
•
Web-based screening is feasible and acceptable to patients
•
Patient need outstrips mental healthcare provision
How can we ensure that patients who need help receive it?
Web-based interventions for patients with
LTC
•
Bond (2010) – web-based problem-solving intervention led to
reduced depressive symptoms in older adults with diabetes (n=62)
•
Van Bastelaar (2011) – web-based CBT was effective in reducing
depressive symptoms in patients with Type I and Type II diabetes
(n=225)
•
Boeschoten (2011) – web-based problem-solving intervention for
depressive symptoms in patients with multiple sclerosis (n=44)
•
Cockayne (2011) – RCT of online CBT for patients with depression
and comorbid cardiovascular disease (protocol)
Limitations of web-based interventions..
Benefits of web-based interventions..
Research opportunities
IMPARTS
screening
data
EPR clinical &
demographic
data
Analyses will investigate
question
of relevance to the health and
experiences of KHP patients
e.g.
IMPARTS
pseudonomysed
Research Database
RESEARCHE
R
•
Patterns of mental disorder,
symptoms, disability & health
behaviour
•
Associations of measured
outcomes with demographic &
clinical variables
•
Predictors of good and poor
outcomes
•
Comparative effectiveness
studies
•
Pathways through care
Recruitment into trials
• We are seeking ethical approval to prospectively request consent for
contact
via the IMPARTS screening interface
• It will be possible to deanonymise patient records to allow researchers
to
contact potential trial participants –when explicit consent has been
given
• Opportunity to trial web-based interventions:
- in different physical health settings (e.g. rheumatology, obesity,
orthopaedics, cancer, renal, cardiology)
- for different mental health problems (e.g. depression, anxiety,
alcohol
and substance misuse, post-traumatic stress disorder)
• Also scope for web-based interventions designed to support disease
self-
Prof Matthew Hotopf
Project Lead
Email: [email protected]
Dr Lauren Rayner
Project Coordinator
Email: [email protected]
Long-term view: