Evaluation of a Collaborative Mental Health Care System (MED@PSY)

Intermunicipal Hospital Center Toulon

Status: Enrolling

Conditions: Psychiatric Adults Patients

Treatments: Other: Clinical assessment by emergency psychiatrist; Other: Psychiatric consultation booked through Med@Psy platform

Study type: Interventional

Funder types: Other

Identifiers

NCT06581874

2024-A01115-42 (Other Identifier)

2024-CHITS-005

Details and patient eligibility

About

In the absence of easy access to second-line ambulatory care, the number of 'inappropriate' psychiatric emergency visits is increasing, with emergency departments becoming the gateway to mental health care.

This is the context in which the 'med@psy' system was set up in the Toulon-Provence-Mediterranean metropolitan area by a private psychiatrist. It facilitates access to psychiatric second referral for General Practitioners (GPs) by pooling the 48-hour supply of psychiatric consultations in real time. It is assumed that this system will facilitate access to outpatient psychiatric care and help to optimize the organisation of patient care and follow-up. The aim of this study is to evaluate the med@psy system in the care pathway for patients with psychiatric disorders.

This study main objective is to compare the proportion of patients with a psychiatric disorder who will receive outpatient follow-up 1 month after a visit to a psychiatric emergency department without hospitalization (Group 1) versus 1 month after a consultation with a psychiatrist within 48 hours via the med@psy system (Group 2).

Full description

General practitioners (GPs) are the gateway to the healthcare system and therefore the first point of contact for mental health. A significant proportion of psychiatric disorders can be treated in primary care if GPs have easy access to psychiatric support. However, they are faced with difficulties in accessing secondary care. Around 9/10 consider that it is more difficult to obtain specialist advice than for other disciplines, and say they have difficulty referring a patient for mental health care.

In the absence of easy access to second-line ambulatory care, the number of 'inappropriate' psychiatric emergency visits is increasing, with emergency departments becoming the gateway to mental health care. It is recognized that the deployment of earlier and more graduated care reduces the intensity of disorders, prescriptions for time off work and psychotropic drugs, and hospitalizations.

A new, more preventive, efficient and cost-effective approach to mental health is emerging, with psychiatrists working closely with GPs. This is the context in which the 'med@psy' system was set up in the Toulon-Provence-Mediterranean metropolitan area by a private psychiatrist. It facilitates access to psychiatric second referral for GPs by pooling the 48-hour supply of psychiatric consultations in real time. We assume that this system will facilitate access to outpatient psychiatric care and help to optimize the organisation of patient care and follow-up. The aim of this study is to evaluate the med@psy system in the care pathway for patients with psychiatric disorders.

This study main objective is to compare the proportion of patients with a psychiatric disorder who will received outpatient follow-up 1 month after a visit to a psychiatric emergency department without hospitalization (Group 1) versus 1 month after a consultation with a psychiatrist within 48 hours via the med@psy system (Group 2).

Enrollment: 478 estimated patients

Sex: All

Ages: 18+ years old

Volunteers: No Healthy Volunteers

Inclusion criteria

• Patient ≥ 18 years ;
• Patient presenting to the Centre hospitalier de Toulon La Seyne sur Mer emergency department, with or without referral, and receiving psychiatric advice with discharge without hospitalization after clinical assessment (Group 1) or patients referred for psychiatric consultation via the Med@psy system (Group 2).
• Patient with indication for outpatient follow-up
• Patient with open social security rights

Exclusion criteria

• Patient's refusal to take part in research ;
• Patient currently being followed by a psychiatrist. Psychiatric follow-up is defined as at least one consultation with a psychiatrist in the last 3 months, outside an unscheduled care consultation or in an emergency department;
• Patients referred for a suicide attempt, violent or non-violent, serious or non-serious;
• Patients without a declared general practioner;
• Patients already included in the study;
• Patients who do not speak French;
• Patients under judicial protection (guardianship, curatorship, etc.) or safeguard of justice;
• Patient under compulsory care, under a care order or deprived of liberty.
• Any other reason which, in the investigator's opinion, could interfere

Trial design

Primary purpose: Health Services Research

Allocation: Non-Randomized

Interventional model: Parallel Assignment

Masking: None (Open label)

---

478 participants in 2 patient groups

Emergency

Sham Comparator group

Description:

Adult patients presenting to the emergency department of the Centre Hospitalier Intercommunal de Toulon La Seyne sur Mer, whether or not referred by their general practitioner.

Treatment:

Other: Clinical assessment by emergency psychiatrist

Med@Psy Platform

Experimental group

Description:

Adult patients referred by their general practioner for a psychiatric consultation via the med@psy system.

Treatment:

Other: Psychiatric consultation booked through Med@Psy platform