The Western Norway Mental Health Interface Study on Referral Letters
The main object to this trial is to study the function of referral letters as a mean to coordinate the care process for adult people when referred from Primary Care to Specialised Mental Health Care. The study will explore if and to what degree the quality of these referral letters can be improved, and the potential improvement's impact on defined patient-, professional and organisational related outcomes. According to Medical Research Council guidelines for evaluating complex interventions, a stepwise design with the use of both qualitative and quantitative methods will be used to conduct a controlled intervention study.
|Study Design:||Allocation: Randomized
Endpoint Classification: Safety/Efficacy Study
Intervention Model: Parallel Assignment
Masking: Single Blind (Outcomes Assessor)
Primary Purpose: Health Services Research
|Official Title:||Interface Between Primary Care and Specialist Mental Health Care - the Referral Letters|
- Length of stay [ Time Frame: Day of discharge assessed up to six months ] [ Designated as safety issue: No ]From date of admission or onset of out-patient treatment until date of discharge (documented in Electronic Patient Record as end of treatment periode), assessed up to six months from admission.
- Response time for referral letters in Specialised Mental Health Care [ Time Frame: Referral letters will be followed for the duration of the assessment and prioritation process until response letter is sent, an expected avarage of 10 days. ] [ Designated as safety issue: Yes ]Unit of measure: Number of days from receiving a referral letter to the response letter is sent to the patient and the General Practitioner. The response time for all letters recieved in a six month periode before the intervention to improve the quality of referral letters will be compared with the response time after the intervention.
|Study Start Date:||August 2010|
|Estimated Study Completion Date:||April 2014|
|Estimated Primary Completion Date:||June 2013 (Final data collection date for primary outcome measure)|
Experimental: Participating GPs
GPs working at randomly selected GP centers/offices within the region that are invited to participate and signs a written informed consent to participate. (N=30-40)
Other: Quality improvement intervention
A complex intervention will be implemented within the group of GPs in the intervention group. It includes participation in defining criteria for good referral letters, information about the correlation between information in the referral letters and outcome, introduction to the guideline, and consecutive feedback on own preformance regarding content of referral letter and outcome for the patient.
No Intervention: Control group
GPs working at randomly selected GP centers/office within the region that are not invited to participate, will form the control group. (N=30-40)
The study is based on a stepwise progression including four steps. Within step one group interview with four mixed groups of health professionals (both Primary and Specialised Care), patient representatives and managers will be conducted. The groups will give input on firstly, what information they think is important to include in the referral letters, and secondly, what impact they think improved referral letters can have for the organisation and care within Specialised Mental Health Care. Within step two a validated check-list to assess the quality of referral letters will be developed. Within step three outcome measures will be developed and tested. Both step two and three will make use of the results from step one in addition to existing literature and testing. Step four is the intervention study where measures from the former steps will be used.
|Helse Fonna Local Health Authorities|
|Haugesund, Norway, 5504|
|Study Chair:||Aslak B Aslaksen, MD, PhD||Faculty of Medicine and Dentistery, University of Bergen, Norway|
|Principal Investigator:||Kjell Haug, MD, PhD||Faculty of Medicine and Dentistery, University of Bergen, Norway|
|Principal Investigator:||Kris Vanhaecht, RN, PhD||Katholieke Universiteit Leuven, Belgium|