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标题：Deploying eHealth: a new approach to face depression in the basque country
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作者：Jon Txarramendieta Suarez ; Ane Fullaondo Zabala ; Esteban de Manuel Keenoy 等
期刊名称：International Journal of Integrated Care
电子版ISSN：1568-4156
出版年度：2017
卷号：17
期号：5
DOI：10.5334/ijic.3421
出版社：Utrecht University, Maastricht University, Groningen University
摘要：Introduction/context : Depression is one of the most frequent mental health diseases worldwide, with approximately 350 million of individuals affected. Antidepressants are still the mainstay of treatment for depression in healthcare settings. In the Basque Country, about 400.000 people suffer from depression; 10% of them with mild or moderate symptoms. cCBT has proven to be effective to fight depression, enabling the patient to change destructive patterns. This type of cCBT can be self-administrated at any time and place; this is why it contributes to improve accessibility to treatment. Also, it enables the delivery of care at the natural environment, minimizing the negative effect of mental health stigma, and contributing to the acceptance of the one's own condition. Description/aim : The Basque Country, within the European project Mastermind, has deployed a Computerized Cognitive Behavioral Therapy (cCBT) service. The Mastermind project started in March 2014 and finishes in Febrary 2017. During the implementation phase, barriers and facilitators related to both clinical and organizational areas have been identified and analyzed. The cCBT platform enables a two-way patient-professional communication, a close patient´s follow-up, while providing the patient with tools to manage its own condition and prevent future episodes. Methods : The practice being implemented in the Basque Country comprises three main work areas: 1. Develop a cCBT platform, called “Supera tu depresión” together with other 3 Spanish partners of the project, taking into account the needs for patient-professional interaction and fluid communication, integration within information systems and therapeutic content that nurtures the platform. The piloting in the Basque Country started in January 2016 and finishes in Febrary 2017, due to the finalisation of the project. 2. Deploy a protocol for comprehensive care that includes key professionals (primary care, mental health and emergency) adapted to the context of the Basque Country. 3. Put into practice an integrated care intervention targeting individuals over 18 years old, diagnosed of low or mid depression. 4. Pre-post assessment of quantitative and qualitative aspects (by focus groups to clinicians and semi structured interviews to managers) according to the MAST model. Results/discussion/lessons learned : The results are to be measured according to the MAST model in terms of health problems, application features, safety, clinical effectiveness, patient and professional perspective and economic, organizational, socio-cultural, ethical and legal aspects. The following data is being analyzed in the Basque Country and the results will be published in the first quarter of 2017. Out of the 182 patients took part in the project, 23 have finalized the therapy and 89 are drop outs. Nowadays, 70 patients still continue in the therapy, and their data will be analyzed after the finalization of the project (Febrary 2017). Although the overall quantitative analysis is ongoing, some conclusions can be highlighted from the qualitative perspective: The patients who complete the therapy are very satisfied with it, although the technical difficulties and lack of time of the professionals have been important barriers. The simplicity of the software and its robustness has been identified as critical success factors, both for patients and professionals. This project will raise awareness about the key issues underpinning online cCBT integration within regular care, generating the knowledge and expertise needed for the extension of this type of care. Transferability : The inclusion of the therapy in the day-to-day practice is being raised in the Basque public Health Provider, Osakidetza. The final decision will depend on the results of the analysis that are being performed during the last months of 2016. If positive, the possibility to provide the cCBT service using existing corporative tools will be assessed.
关键词：computerized cognitive behavioral therapy (ccbt) ; ccbt platform ; mental health ; depression ; integrated care ; patient-professional interaction