Psychiatric Consultation-Liaison Intervention in Primary Care: A Pilot Study

Condition(s) studied

Investigational drug(s) / intervention(s)

Intervention arm - Consultation-Liaison (CL) brief psychiatric intervention in primary care settings: The CL brief psychiatric intervention (2 months) in the primary setting will consist of 3 different phases: 1. A direct referral of their PCP to the practice's CL psychiatrist will be held directly after the inclusion of the patient to the intervention arm, by conducting a clinical exchange (by oral or by mail) with the latter. 2. The CL psychiatrist will organize rapidly (in a delay of 1-2 weeks) a first session and will perform 1 to 4 psychiatric sessions, depending on the participant's needs. These sessions will take place in his/her consultation room, located in the referring PCP's practice, and will be completed in less than 2 months. No intervention guide will be provided to perform these sessions. 3. A joint feedback session between the PCP, the participant, and the CL psychiatrist will be organized (2 months after the first psychiatric session), during which the CL psychiatrist will make restitution of his/her proposals, from a biopsychosocial perspective.

Control Arm - Treatment As Usual (TAU): PCPs will explain to the participants that they will treat their psychological suffering, by providing the usual care for patients with psychiatric co-morbidities. Treatment as usual (TAU) by the PCP may involve supportive care (psychoeducation, psychotherapeutic support, social interventions, etc.), referral to a mental health provider (psychotherapist, psychiatrist, psychiatric nurse, etc.), treatment with psychotropic drugs, hypnosis, acupuncture, relaxation, etc. So as to facilitate their task, PCPs participating in this study will be provided with a list of mental health workers that they could contact.

Study summary

The pilot study on the impact of a Psychiatric Consultation-Liaison Intervention in Primary Care Medical Consultations in French-speaking Switzerland (PLIMeC-P), is a mixed method randomized controlled trial. The investigated health-related intervention is a brief Consultation-Liaison (CL) psychiatry intervention in primary care.

Primary Care Physicians (PCPs) have a key role in preventing, detecting, and managing mental disorders. Therefore, the optimization of both the quality of their interventions and their cooperation with psychiatric and psychological care networks are important challenges. It is well demonstrated that multidisciplinary interventions improve the efficacy of mental health care, CL psychiatry being one such type of intervention. Therefore, community CL-psychiatry, for example in private primary care group practices, are rare. The impact of such community, primary care CL-psychiatry interventions, should be investigated.

The mixed methods randomized controlled trial PLIMeC study will examine the impact of a CL-psychiatric intervention in primary care settings, for newly reported mental illness, versus a Treatment As Usual (TAU) control arm. The intervention consists of a CL-psychiatric intervention into private medical practices, provided to patients suffering from mental health problems, a group of patients generally under-treated. The CL-psychiatrist will receive and discuss PCPs' referrals for patients with mental distress, who don't have a psychiatric follow-up. After a brief intervention (1-4 sessions), feedback conjoint (PCP-psychiatrist) session will be organized, to complete the intervention and provide proposals.

The pilot study (PLIMeC-P) will determine whether the main planned study (PLIMeC) is feasible and practicable. It will be conducted on two sites, the Neuchâtel Psychiatry Centre (CNP) and the North-west Adult Psychiatry Service (SPANO), Department of Psychiatry of CHUV, Yverdon. For the pilot study (PLIMeC-P), 15 eligible participants are expected for each group, 30 participants in total. They will be recruited in three private primary care group practices. After eligibility and randomization 15 participants will be included for the intervention arm (brief CL-psychiatric intervention) and 15 for the control arm (TAU). The expected number of participants for the main trial (PLIMeC) will be estimated through analysis of the initial results of the PLIMeC-P.

Eligibility

Primary outcome measure(s)

• Evaluate the feasibility of the main PLIMeC study — Up to 20 months
  The feasibility of the main study will be measured by the percentage (%) of participants in the pilot study who will have completed all the planned assessments during the 4 time points (T0 - T3). Feasibility will be assured if a percentage greater than 50% is obtained.
• Mental health - psychiatric symptoms — After enrolment, one-year follow-up will be carried out for each participant. Measurements will be performed at baseline, 3, 6 and 12 months (T0, T1, T2 and T3) for the intervention and control groups.
  The evolution of participants' psychiatric symptoms with the Primary Care Evaluation of Mental Disorders (PRIME-MD) scale and more specifically with its three sub-scales: Patient Health Questionnaire Somatic (PHQ-15 score ranges from 0 to 30), Anxiety (GAD-7 score ranges from 0 to 21), and Depressive Symptom Scales (PHQ-9 score ranges from 0 to 27). Regarding each of the 3 sub-scales, a reduction of more than 5 points will be deemed as clinically relevant.
• Mental health - Quality of life — After enrolment, one-year follow-up will be carried out for each participant. Measurements will be performed at baseline, 3, 6 and 12 months (T0, T1, T2 and T3) for the intervention and control groups.
  The evolution of participants' quality of life with the WHOQOL-BREF questionnaire, focusing on the psychological domain (Domain - 2 score ranges from 6 to 30). WHOQOL-BREF increase of 2.8 points on the psychological domain will be deemed as clinically relevant.
• Mental health - Self-report questionnaire — After enrolment, one-year follow-up will be carried out for each participant. Measurements will be performed at baseline and 12 months (T0 and T3) for the intervention and control groups.
  A self-report questionnaire, which will include measures on demographic, psychiatric, and quality of life variables.

Trial sites (3)

More Center for Primary Care and Public Health (Unisante), University of Lausanne, Switzerland trials in Switzerland

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