ABSTRACT
BACKGROUND: Substantial data from high-income countries support early interventions in the form of evidence-based Coordinated Specialty Care (CSC) for people experiencing First Episode Psychosis (FEP) to ameliorate symptoms and minimize disability. Chile is unique among Latin American countries in providing universal access to FEP services through a national FEP policy that mandates the identification of FEP individuals in primary care and guarantees delivery of community-based FEP treatments within a public health care system. Nonetheless, previous research has documented that FEP services currently provided at mental health clinics do not provide evidence-based approaches. This proposal aims to address this shortfall by first adapting OnTrackNY (OTNY), a CSC program currently being implemented across the USA, into OnTrackChile (OTCH), and then examine its effectiveness and implementation in Chile. METHODS: The Dynamic Adaptation Process will be used first to inform the adaptation and implementation of OTCH to the Chilean context. Then, a Hybrid Type 1 trial design will test its effectiveness and cost and evaluate its implementation using a cluster-randomized controlled trial (RCT) (N = 300 from 21 outpatient clinics). The OTCH program will be offered in half of these outpatient clinics to individuals ages 15-35. Usual care services will continue to be offered at the other clinics. Given the current COVID-19 pandemic, most research and intervention procedures will be conducted remotely. The study will engage participants over the course of 2 years, with assessments administered at enrollment, 12 months, and 24 months. Primary outcomes include implementation (fidelity, acceptability, and uptake) and service outcomes (person-centeredness, adherence, and retention). Secondary outcomes comprise participant-level outcomes such as symptoms, functioning, and recovery orientation. Over the course of the study, interviews and focus groups with stakeholders will be conducted to better understand the implementation of OTCH. DISCUSSION: Findings from this study will help determine the feasibility, effectiveness, and cost for delivering CSC services in Chile. Lessons learned about facilitators and barriers related to the implementation of the model could help inform the approach needed for these services to be further expanded throughout Latin America. TRIAL REGISTRATION: www. CLINICALTRIALS: gov NCT04247711 . Registered 30 January 2020. TRIAL STATUS: The OTCH trial is currently recruiting participants. Recruitment started on March 1, 2021, and is expected to be completed by December 1, 2022. This is the first version of this protocol (5/12/2021).
Subject(s)
COVID-19 , Psychotic Disorders , Adolescent , Adult , Chile , Humans , Psychotic Disorders/diagnosis , Psychotic Disorders/psychology , Psychotic Disorders/therapy , Randomized Controlled Trials as Topic , Young AdultABSTRACT
Background: A telehealth mental health programme was designed at the LivingLab of the Faculty of Medicine of the Universidad de Antioquia [University of Antioquia].Objectives: To describe the development and operation of the programme and evaluate the satisfaction of the patients treated during the COVID-19 pandemic in 2020 and 2021.Methods: Descriptive study that details the development of the programme. Data were extracted from medical records to describe the patients who were treated. A satisfaction scale was applied to a random sample and the data were summarised with descriptive statistics.Results: In March 2020 and August 2021, 10,229 patients were treated, with 20,276 treated by telepsychology and 4,164 by psychiatry, 1,808 by telepsychiatry and 2,356 by tele-expertise, with a total of 6,312 visits. The most frequent diagnoses were depressive (36.8%), anxiety (12.0%), and psychotic (10.7%) disorders. Respondents were satisfied to the point that more than 93% would recommend it to another person.Conclusions: The LivingLab telehealth mental health programme allowed for the care of patients with mental health problems and disorders in Antioquia during the first two years of the COVID-19 pandemic, and there was a high degree of satisfaction among the beneficiaries. Therefore it could be adopted in mental health care.
ABSTRACT
Introducción: En el LivingLab de la Facultad de Medicina de la Universidad de Antioquia se diseñó un programa de telesalud mental. Objetivo: Describir el desarrollo y el funcionamiento del programa y evaluar la satisfacción de los pacientes atendidos en 2020 y 2021 durante la pandemia de COVID-19. Métodos: Estudio descriptivo que detalla el desarrollo del programa. Se extrajeron los datos de las historias clínicas para describir a los pacientes atendidos. Se aplicó una escala de satisfacción a una muestra aleatoria y se resumieron los datos con estadística descriptiva. Resultados: Durante marzo de 2020 y agosto de 2021, se atendió a 10.229 pacientes con 20.276 atenciones por telepsicología y 4.164 por psiquiatría, 1.808 en la modalidad de telepsiquiatría y 2.356 en la de teleexperticia, con un total de 6.312 atenciones. Los diagnósticos más frecuentes fueron trastornos depresivos (36,8%), ansiosos (12,0%) y psicóticos (10,8%). Los encuestados se mostraron satisfechos, al punto de que más del 93% recomendaría el programa a otra persona. Conclusiones: El programa de telesalud mental del LivingLab permitió la atención de pacientes de Antioquia con problemas y trastornos mentales durante los primeros 2 años de la pandemia de COVID-19 y los beneficiarios mostraron un alto grado de satisfacción, por lo que podría adoptarse para la atención en salud mental.