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Jornada de Proyectos Europeos H2020
Oportunidades de Colaboración en Proyectos Europeos Jornada de Proyectos Europeos H2020
Oportunidades de Colaboración en Proyectos Europeos
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
• 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
cCBT
ccVC cCBT
cCBT
Baseline in Sector Sanitario de Barbastro
Aragón
Project
The road to implementation:
Definition Execution Assessment Implementation
MAST Patient
Mental
Health Unit
Primary Care
Technical Support
Contact
Center
• Patient QoL • Professionals satisfaction • Quality of service • Sustainability
MasterMind. Pilot Definition
Mastermind
Generic Protocol
Spanish Cluster
Supera Tool
Common protocol
Lessons learnt from 1st wavers
Changes on local protocol
Institution Objectives and
resources
(and evolution!)
MasterMind. Project Execution
https://www.youtube.com/watch?v=q-CjX2hQvnU
Target : 100 patients 2nd wave
Service ccBT ccVC
Dates Oct 2015 -> ongoing Jan 2015 -> ongoing
Area of coverage Sector Sanitario Barbastro Lafortunada Healthcare Area
Recruitment / Follow up
Primary Care/ Mental Health Unit
Primary Care <-> Mental Health Unit
Professionals involved
3 psychiatrists 2 psychologist 5 nurses 7 GPs
4 psychiatrists 3 GPs 1 nurse
Technological developments
- Screening Tests (Intranet) - Tool Supera Tu depresión (Spanish Cluster)
- Selection of patients for sessions - Interchange of information during sessions
Patients included (11th May 2017)
140 26
Patient
Mental Health Unit
Primary Care
Technical Support
Contact Center
Module 1
What is
depression?
Module 2
How different
activities affect
our mood?
Module 3
Increasing
pleasant
activities
Module 4
How thoughts
affect our
mood
Module 5
Learning to
change our
negative
thoughts
Module 6
Learning to change
our negative
thoughts:
negative situations
Module 7
Increasing
social
Activities
Module 8
Looking at
the future
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
MasterMind (ccBT). Project Execution
MasterMind (ccBT). Project Execution
Inclusion Criteria
Initial Assessment
Informed Consent
Training session
Follow-up
Final Evaluation
• Inclusion >= 18 years, depression, use of mobile • Exclusion: comorbidities, risk of autolysis
• Generate confidence with the online tool • Questionnaires, first approach • Strenght commitment
• Through platform and through email. 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.
MasterMind (ccVC). Project Execution
UCSM Mental Health
Collaborative Unit
• 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 2015 -> Now • Why: To reduce consultations in MHU, to increase
information about patients, to reduce travels, to improve care quality
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
Health problem
Patient Safety
Clinical Efective
ness
Patient and Professional
Economic Aspects
Organisational
Aspects
Socio-ethical
and legal
http://mafeip.eu/assets/files/07_UC7_MastermindcCBT_AR_20170704.pdf
MasterMind(ccBT). Project Assessment.
Clinical outcomes
52% in
module 2
48% in
module 4
33% in
module 8
8,27% did not reach 8 but no symptoms in last
control
0
2
4
6
8
10
12
14
16
Session 0 Session 2 Session 4
QO
L/ M
H
DEP
RES
SIO
N
Patients in module 4
0
2
4
6
8
10
12
14
16
Session 0 Session 2 Session 4 Session 6
QO
L/ M
H
D
EPR
ESIO
N
Patients in module 6
0
2
4
6
8
10
12
14
16
Session 0 Session 2 Session 4 Session 6 Session 8
QO
L/M
H
D
EPR
ESIO
N
Patients in module 8
41, 35%
Reached module 8 or reached at least module 5 and did not show symptoms
during the last control
0,62 alarms per patient (triggered by result on questionnaire that showed severe depression and /or risk of autolysis
MasterMind(ccVC). Project results
• 36 patients
• 219 consultations
• 23 sessions
• 0 admissions in the
acute mental health unit
• Less consultations • Early detection of
symptoms
Since Jan 2015
0
2
4
6
8
10
12
14
16
18
20
Patients / session
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
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,…)
ccBT Evaluation of impact: MAFEIP
Health states transition
Costs Utitily
(HRQoL)
Resources Health
• Age-related incremental value • Cost-effectiveness • Cumulative utility • Transitions between health states
IMPACT
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: pre-post (likert scale 7 values)
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
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
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: +34 974 249 011 Innovation.hbrb@salud.aragon.es