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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