An integrated model of care for young people with liver disease and transplant

Abstract

Rationale, aims and objectives: Young people (YP) with chronic illness have increased risk of mental health problems. This paper evaluates the feasibility, acceptability and effectiveness of incorporating routine electronic mental health screening into the standard multidisciplinary healthcare of YP with chronic liver disease and liver transplant.Methods: One hundred and eighty-seven YP (mean age 18 years, 53% female) attending routine appointments in a tertiary service in the UK completed mental health screening prior to their clinic appointment. These standardized measures (the 9-item Patient Health Questionnaire [PHQ9] and the 7-item Generalised Anxiety questionnaire [GAD7]) were completed using an informatics system that facilitates routine collection of patient-reported outcomes, with real-time feedback to guide clinical care. Responses are immediately uploaded to medical notes and evaluated by the clinical team. Fifty-three YP completed an additional feasibility measure. YP screening positive were assessed by the clinical team, with appropriate support offered. Level of clinician agreement with screening programme was ascertained by the team’s clinical psychologist.Results: YP reported that completing the electronic screening was acceptable, a positive experience and that routine mental health screening in this manner would not affect the way they felt about coming to clinic. Clinician judgement corroborated 31 of the 33 YP who screened as positive for anxiety/depression. Screening did not effectively identify all YP warranting psychosocial input.Conclusions: Screening using electronic measures, with responses uploaded in real-time to medical notes for consultant review, can facilitate the rapid identification of mental health problems in YP with physical health problems, in an acceptable and time/cost-effective way. This should be combined with the support of embedded mental health practitioners within physical healthcare environments.