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 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 , 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.
Of the planned video consultations, 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. Keywords: anxiety; depression; integrated care; primary care; randomized controlled trial; recovery; telepsychiatry; videoconferencing.
