Background: Most people affected by depression or anxiety disorders are treated solely by their primary care physician. Access to specialized mental health care is impeded by patients’ comorbidity and immobility in aging societies and long waiting times at the providers’ end. Video-based integrated care models may leverage limited resources more efficiently and provide timely specialized care in primary care settings. Objective: The study aims to evaluate the feasibility of mental health specialist video consultations with primary care patients with depression or anxiety disorders. Methods: Participants were recruited by their primary care physicians during regular practice visits. Patients who had experienced at least moderate symptoms of depression and/or anxiety disorders were considered eligible for the study. Patients were randomized into 2 groups receiving either treatment-as-usual as provided by their general practitioner or up to 5 video consultations conducted by a mental health specialist. Video consultations focused on systematic diagnosis and proactive monitoring using validated clinical rating scales, the establishment of an effective working alliance, and a stepped-care algorithm within integrated care adjusting treatments based on clinical outcomes. Feasibility outcomes were recruitment, rate of loss to follow-up, acceptability of treatment, and attendance at sessions. Effectiveness outcomes included depression (Patient Health Questionnaire-9), anxiety (Generalized Anxiety Disorder-7), burden of specific somatic complaints (Somatic Symptom Disorder-B Criteria Scale-12), recovery (Recovery Assessment Scale-German [RAS-G]), and perception of chronic illness care (Patient Assessment of Chronic Illness Care), which were measured at baseline and 16 weeks postallocation by assessors blinded to the group allocation. Results: A total of 50 patients with depression and/or anxiety disorders were randomized, 23 in the intervention group and 27 in the treatment-as-usual group. The recruitment yield (number randomized per number screened) and the consent rate (number randomized per number eligible) were 69% (50/73) and 86% (50/58), respectively. Regarding acceptability, 87% (20/23) of the participants in the intervention group completed the intervention. Of the 108 planned video consultations, 102 (94.4%) were delivered. Follow-up rates were 96% (22/23) and 85% (23/27) for the intervention and control groups, respectively. The change from baseline scores at postmeasurement for the No Domination by Symptoms domain of recovery (RAS-G) was somewhat higher in the intervention group than in the control group (Mann-Whitney U test: rank-biserial r=0.19; 95% CI −0.09 to 0.46; P=.18). We did not detect any notable differences between the intervention and control groups in terms of other effectiveness outcomes. We did not observe any serious adverse events related to the trial. Conclusions: The intervention and study procedures were found to be feasible for patients, primary care practice staff, and mental health specialists. A sufficiently powered pragmatic trial on mental health specialist video consultations should be conducted to investigate their effectiveness in routine care. Trial Registration: German Clinical Trials Register DRKS00015812; https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00015812.

中文翻译：

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在初级保健中患有抑郁症或焦虑症的心理健康专家视频咨询与常规治疗相比：随机对照可行性试验

背景：大多数受抑郁症或焦虑症困扰的人都只能由其初级保健医生来治疗。患者在老年社会中的合并症和行动不便以及提供者的长期等待时间，阻碍了获得专门的精神保健服务。基于视频的综合护理模型可以更有效地利用有限的资源，并在初级护理环境中提供及时的专业护理。目的：该研究旨在评估心理健康专家视频咨询对抑郁症或焦虑症初级保健患者的可行性。方法：参与者是由他们的初级保健医生在定期的实践访问中招募的。至少经历了中度抑郁症和/或焦虑症症状的患者被认为符合研究条件。将患者随机分为两组，分别接受全科医生提供的常规治疗或心理健康专家进行的多达5次视频咨询。视频咨询的重点是使用经过验证的临床评分量表进行系统的诊断和主动监测，建立有效的工作联盟以及在综合护理中根据临床结果调整治疗的分步式护理算法。可行性结果是招募，失访率，治疗的可接受性和参加会议。结果：共有50例抑郁和/或焦虑症患者被随机分组​​，干预组为23例，常规治疗组为27例。招募率（按筛选的人数随机分配的人数）和同意率（按符合条件的人数随机分配的人数）分别为69％（50/73）和86％（50/58）。关于可接受性，干预组中87％（20/23）的参与者完成了干预。在计划的108个视频咨询中，有102个（94.4％）已交付。干预组和对照组的随访率分别为96％（22/23）和85％（23/27）。干预组的“无症状主导的恢复”域（RAS-G）的测量后基线得分变化比对照组高（Mann-Whitney U测试：秩为双数r = 0.19；95％CI -0.09至0.46; P = .18）。在其他有效性结果方面，我们没有发现干预组和对照组之间有任何显着差异。我们没有观察到与试验相关的任何严重不良事件。结论：干预和研究程序被发现对患者，初级保健实践人员和心理健康专家是可行的。应当进行足够有力的心理健康专家视频咨询的实用试验，以调查其在常规护理中的有效性。试验注册：德国临床试验注册DRKS00015812；https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00015812。