Primary care patients in psychiatric clinical trials: a pilot study using videoconferencing.

Janet B W Williams,Amy Ellis,Arthur Middleton,Kenneth A Kobak

doi:10.1186/1744-859x-6-24

Janet B W Williams, Amy Ellis + Show 2 more

Open Access

https://doi.org/10.1186/1744-859x-6-24

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Abstract

BackgroundWhile primary care physicians play a pivotal role in the treatment of depression, collaboration between primary care and psychiatry in clinical research has been limited. Primary care settings provide unique opportunities to improve the methodology of psychiatric clinical trials, by providing more generalizable and less treatment-resistant patients. We examined the feasibility of identifying, recruiting, screening and assessing primary care patients for psychiatric clinical trials using high-quality videoconferencing in a mock clinical trial.Methods1329 patients at two primary care clinics completed a self-report questionnaire. Those screening positive for major depression, panic, or generalized anxiety were given a diagnostic interview via videoconference. Those eligible were provided treatment as usual by their primary care physician, and had 6 weekly assessments by the off-site clinician via videoconferencing.Results45 patients were enrolled over 22 weeks, with 36 (80%) completing the six-week study with no more than two missed appointments. All diagnostic groups improved significantly; 94% reported they would participate again, 87% would recommend participation to others, 96% felt comfortable communicating via videoconference, and 94% were able to satisfactorily communicate their feelings via video.ConclusionResults showed that primary care patients will enroll, participate in and complete psychiatric research protocols using remote interviews conducted via videoconference.

Highlights

While primary care physicians play a pivotal role in the treatment of depression, collaboration between primary care and psychiatry in clinical research has been limited
There is some evidence that primary care patients may be less likely to respond to placebo: in a series of four generalized anxiety disorder studies, a 20% higher placebo response rate was found in patients recruited from psychiatric settings as compared to primary care sites [9]
The current study examined the feasibility of identifying, recruiting and screening primary care patients for clinical trials, and examined patient comfort, satisfaction, and adherence in a mock clinical trial using high-quality videoconferencing for screening and ongoing evaluations by remote raters

Summary

Introduction

While primary care physicians play a pivotal role in the treatment of depression, collaboration between primary care and psychiatry in clinical research has been limited. Primary care settings provide unique opportunities to improve the methodology of psychiatric clinical trials, by providing more generalizable and less treatment-resistant patients. Primary care physicians have long been recognized as playing a pivotal role in the treatment of depression, providing the majority of all mental health treatments for this disorder [1,2]. They are often the first point of contact for patients with mental health concerns. The high prevalence rate of depression and other mental health disorders in primary care can help facilitate patient recruitment for clinical trials

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Conclusion