eHealth tools for the optimisation of care for patients with mental disorders

1. eHealth tools for the optimisation of care for patients with mental disorders Hans Kordy Center for Psychotherapy Research, University of Heidelberg 3rd Ministerial European eHealth Conference and Exhibition, Tromsoe, Norway, 2005

2. eHealth at the Centre for Psychotherapy Research • „Internet-Bridge“: maintenance group setting (Valiollah Golkaramnay, Dipl.-Psych., Severin Haug, Dipl.-Psych.) • „e-mail Bridge“: maintenance individual setting (Markus Wolf, Dipl.-Psych.) • „Relapse prevention through SMS-Monitoring“ (Stephanie Bauer, PhD) • „Web-AKQUASI“: quality management & outcome monitoring (Robert Percevic, PhD, Christine Gallas, Dipl.-Psych.)

3. Project “Internet-Bridge” • A collaborative enterprise of various stakeholders: • Research: Forschungsstelle für Psychotherapie • Clinical Provider: Panorama-Klinik Scheidegg/Allgäu • Insurance/Payer: Techniker Krankenkasse

4. Project „Internet-Bridge“ - Background Need for step-down maintenance programmes Patients with mental disorders • benefit substantially from inpatient care • are at high risk to lose achieved gains • wish to continue treatment • are recommended to do so • but, current service conditions make this difficult.

5. Project „Internet Bridge“ Strategy • Maintenance approach / relapse prevention • Group therapy in an Internet chat-room • Outcome monitoring

6. Project „Internet Bridge“ Clinical concept - group setting • 8–10 participants (disorder unspecific) • open groups • programme duration: 12-15 weekly sessions • session duration: 90 min. • groups are guided by experienced group therapists

7. Project „Internet Bridge“- Connecting people Participants Hospital / Therapists Center for PT Research / Server

8. Project „Internet Bridge“ Technical background • Server • Software • Technical administration and support • Homepage • Training of therapists and patients

9. Project „Internet Bridge“ Security and confidentiality • Chat-room: password-protected • Online questionnaires: password-protected • Passwords: changing regularly • Communication: pseudonyms • Data transfer: encoded (SSL) • Server: firewall

10. Project „Internet Bridge“ Continuous monitoring • Software: Web-Akquasi • Pre-session questionnaires (current impairment / symptoms) • Post-session questionnaires (session evaluation items / satisfaction)

11. AKQUASI - Outcome Monitoring continue therapy (predominantly improvements) Scale State Change Last Change Psychological distress Physical impairment Interpersonal impairment Social impairment Coping Resources General life satisfaction Project „Internet Bridge“ Continuous monitoring • Software: Web-Akquasi • Feedback on symptom status and change

12. Legal aspects Principle: avoid negligence! • data protection and privacy • professional standards / code of professional conduct • liability law • criminal law

13. Emergency measures • face-to-face diagnosis at beginning • Hospital emergency service (24 hours) • Therapist’s telephone – 90 min after session • Check of health/mood status at logout • Local emergency contact (e.g. primary carer)

14. Project „Internet Bridge“ – The Study Aims • Feasibility & Reliability • Acceptance • Effectiveness

15. Project „Internet Bridge“ Design 12-15 weekly chat sessions inpatient treatment Chat group 6-months follow-up 12-months follow-up admission discharge inpatient treatment Control group 6-months follow-up 12-months follow-up admission discharge

16. Project „Internet Bridge“ Sample - treatment group: N = 117 patients - control group: N = 117 patients - inpatient treatment - stability at discharge from hospital - internet access - experienced group therapists: • . familiar with specific problems of the patients • . familiar with PC and chat

17. Project „Internet Bridge“ – Study design Sample - diagnosis

18. Project „Internet Bridge“ – Study results Acceptance • Interest for the offer 80% • Drop-out rate 13% • Session attendance 87% • Satisfaction with sessions 90% • - Satisfaction with programme 85%

19. Project „Internet Bridge“ – Study results Evaluation of the setting - Session duration 74% - Weekly sessions 80% - Programme duration 55% - Importance of the therapist 80% - Importance of anonymity 38% - Willingness to pay (privately) 51%

20. Project „Internet Bridge“ – Study results Effectiveness – main criterion: stability of therapeutic gains discharge 6 months fu 12 months fu

21. Project „Internet Bridge“ – Study results Effectiveness – Psychological distress (SCL-90-R)

22. Project „Internet Bridge“ – Study results Effectiveness – Physical impairment (GBB)

23. Project „Internet Bridge“ - Conclusions Chat-groups.... ....proved technically feasible ....are well accepted by patients ....promise effective relapse prevention

24. eHealth - Outlook E-Health tools such as internet chat-groups contribute to the optimisation of care through.... ....facilitating access (bridges geografical and psychosocial distances) ....extending the reach of specialists ....increasing the flexibility of care and carers ....improving the match between patients needs and provided care

25. Invitation For further questions: Kordy@psyres-stuttgart.de Bauer@psyres-stuttgart.de