Status: June 2019
The MenDis-CHD study protocol “Quality of health care with regard to detection and treatment of mental disorders in patients with coronary heart disease (MenDis-CHD): study protocol” has now been published by BMC Psychology and can be found at: https://doi.org/10.1186/s40359-019-0295-y
Recruitment data are currently being adjusted and analysed. A total of four patients (dropouts) were removed from the overall analysis. N=364 patients remained and the values from the March report changed slightly.
The full results will be published as an article soon. First of all it should be said that the patient groups (with a psychological diagnosis vs. without a psychological diagnosis) sometimes have different preferences towards the physicians and the needs are often not covered (e.g. by regular conversation or help offers). In this context, the number of unreported cases of patients who have a mental illness but have not been diagnosed is becoming apparent. The analyses will be continued here.
Further cooperation with the other subprojects will begin in July. OrgValue will develop a paper on the questionnaire validation of the PACIC with regard to our study group. Also a possible networking with OrgValue regarding practitioners will be discussed. The health insurance data from the PMV research group are expected in mid/late July, so that further research can be carried out here as well. MenDis-CHD also registered for a lecture at the DKVF Congress 2019 in Berlin.
Status: January 2018
Due to the good collaboration with our partners from health-care institutions in Cologne, we were able to recruit 330 patients. This exceeds our present target (see figure at the end of the text). The recruitment in rehabilitation clinics has been completed and we are lacking only three more participants in the practices. However, we will recruit some patients beyond the target. If the recruitment can be completed soon, we will additionally focus on the recruitment of women in order to achieve our stated sampling target (50% of the participants should be female in order to optimally represent the sexes). Currently we are focusing on the recruitment in hospitals, where we have already enrolled 74 people.
Moreover, we can report the attendance of 67 relatives/affiliated people who will be approached for the triads (see below). Also, we were able to recruit some practitioners who were willing to complete a questionnaire in addition to participating in the focus groups. For this purpose, we sent out questionnaires to physicians treating patients who were already included in the study.
Additional focus groups were conducted in the hospitals and rehabilitation clinics. At the moment, we are building triads of one CHD patient, one relative/affiliated person and one physician for interviews.
Furthermore, the study protocol for MenDis-CHD was submitted to BMC Psychiatry. In October, we successfully presented a poster explaining our mixed-methods study design at the German Congress for Health Services Research in Berlin.
We recently submitted the follow-up proposal of MenDis I. After constructive discussions with LYOL-C, OrgValue, CoRe-Net, its members and its advisory board, we were able to achieve a satisfying consensus.
The first interim analysis showed a clear trend, as we had hoped prior to the start of the recruitment. The results confirmed our assumptions regarding the current health-care situation in Cologne and are consistent with previous scientific findings. Considerable psychotherapeutic and medical needs were revealed.
Fortunately, we were able to successfully put the patients in contact with psychotherapeutic colleagues in order to ensure professional care.
Status: October 2018
Due to the good collaboration with our partners from health care institutions in Cologne, we were able to recruit 258 patients. This exceeds our present target (see figure at the end of the text). The recruitment in rehabilitation facilities has now been completed and we are currently recruiting additional women in rehabilitation facilities in order to achieve our stated sampling target (50% of the participants should be female in order to optimally represent the sexes). In the practices, we are only lacking a few people. As soon as the recruitment in practices has been completed, we will focus on the recruitment of women here as well. At the moment, the recruitment focus is on hospitals.
The first interim analysis showed a clear trend as we had hoped prior to the start of the recruitment. The results confirmed our assumptions regarding the current health care situation in Cologne and are consistent with previous scientific findings. Considerable psychotherapeutic and medical needs were revealed. Fortunately, we were able to successfully put the patients in contact with psychotherapeutic colleagues in order to ensure professional care.
Additional focus groups were conducted in the hospitals and rehabilitation hospitals. Further data could be collected from practitioners and relatives/affiliated people of patients with CHD. Especially among the relatives/affiliated people of patients, it was striking that they are usually involved too little in the treatment and that uncertainty and burden prevail.
At the moment, we are building triads of one CHD patient, one relative/affiliated person and one physician for interviews.
Furthermore, the study protocol for MenDis-CHD was submitted at BMC Psychiatry. In October, we successfully presented a poster explaining our mixed-methods study design at the German Congress for Health Services Research in Berlin.
The data for the qualitative module is still being collected. A focus group with cardiologists of an acute care hospital was conducted. A first preliminary content analysis showed that no screening for depression or dementia has been carried out. The cardiologists justify this by the fact that the treatment that is stipulated by the DRG is regulated by a fixed schedule. Within this time frame of five to six days, a screening for depression or dementia is not mandatory.
Furthermore, two focus groups with cardiologists, physiotherapists, and psychologists from rehabilitation hospitals were conducted. A first analysis shows that no standardized screening for depression or dementia by means of the HADS or DemTect has been performed. Physicians decide during the anamnesis whether and how they will approach the patients concerning possible depression and if they will send them to psychologists for a psychotherapeutic treatment. Individual interviews with patients, relatives/affiliated people and ambulatory care practitioners are currently being conducted.
Status: July 30, 2018
Through the smooth cooperation with our practice partners, we were able to recruit 263 patients in 6 months. This value is well above the nominal curve (see the graphic below). Especially, the recruitment in practices and rehabilitation clinics runs quickly. In one of the rehabilitation clinics, we examined all required patients. We have now almost reached the destination of our second rehabilitation clinic. Also, in the practices, we will shortly reach the required number of patients. The completed questionnaires were sent to the CoRe-Net trust center, so we can start analyzing the data soon. In several patients, we determined a need for psychotherapy, and we’ve been able to mediate successfully with psychotherapists for professional care.
In the rehabilitation clinics and hospitals, we conducted the first focus groups. Also, we collected data of professional health care providers and relatives of CHD patients. It is striking that relatives are insufficiently included in the treatment, so they are often uncertain.
Currently, we are constructing triads, consisting of a patient with CHD, a relative and a care provider, for conducting interviews with these groups.
Furthermore, we submitted our study protocol to BMC Psychiatry.
In October, we will present our mixed-methods study design at the Congress on Health Care Research in Berlin.
Status: March 14, 2018
Since launching the MenDis-CHD project in February 2017 much has been achieved: We specified the methodological details for the study and received a validated questionnaire covering, for example, patient satisfaction and diagnostic measuring instruments. We designed items for patients, relatives and health care providers, in many individual steps. These items relate to the current state of care and needs, diagnosis and treatment carried out, and the access and barriers to care of CHD patients affected by mental disorders or cognitive impairment. Also, we developed guidelines for the interviews and the focus groups and established a patient ratio. This patient ratio can ensure the optimum distribution among the different interview groups. For conducting the interviews, we took out commuting accident insurance.
The project team members received training on test diagnosis for enabling a validated survey. For instance, the team members attended a workshop on qualitative methods conducted by Prof. McKee. Our study is registered with the German Clinical Trials Register (DRKS). Also, we created the participant information and informed consents, and finalized the questionnaires. There were several meetings with practice partners in which we presented our project and approach. Within the framework of these meetings, we made individual arrange-ments for smooth recruitment in the clinics and practices. We devised a detailed project plan and created standard operating procedures, screenings and identification logs. At the end of September 2017, we received study approval by the Ethics Commission of Cologne University’s Faculty of Medicine.
We are now finalizing the study protocol, which will be our first publication. Further publications in MenDis-CHD are planned. Also, we intend to collectively publish articles with the OrgValue project team, as well as the pmv-research group about secondary data analysis.
Our event “Cologne meets CoRe-Net” took place in November 2017. The report can be found here. The event was a great success and produced stimulating ideas for future projects.
Our study recruitment started in the second week of January 2018.