Internet-based Cognitive Therapy in the Treatment of Patients with Mental Health Problems in General Practice. A Novel Collaborative Model, 2016

In Scandinavian general practice one third of all consultations are due to mental health problems. Many GPs find it difficult to treat psychiatric patients. Specialist mental health care services suffer from many referrals with varying quality. There is a lack of psychiatric specialist health service. Patients will have to wait 3- 6 months for specialist treatment. This delay often aggravates patient symptoms. To overcome varying quality by GPs and referral delay, we need new approaches to patient treatment followed by a more efficient use of the limited resources in the specialized health care. In Northern Norway, 32 % of the population live in rural areas and there is 0,59 psychologist per 1000 inhabitants compared to 1,11 per 1000 in the urban areas of Oslo and Akershus. Long travelling distances to regional hospitals, longer waiting lists, and fewer psychiatric spesialists add to patient sufferings. This also applies to many rural areas in the other Scandinavian countries. By slightly modifying and applying an already existing and well tested internet self help programme for treatment of mental problems and combined with visits to GPs, this project investigated a novel approach of collaboration between patients, GPs and specialist mental health care professionals. The aim was to obtain a more efficient and more qualified patient treatment, better referrals to specialist and safer transition from specialist health care back to GPs. Research question 1: Can the use of the internet-based self-help program BlueMood result in a novel approach of cooperation between patient and general practitioners and yield improved diagnostics and treatment of patients seeking help for depression? Research question 2: Will the use of BlueMood in general practice, result in more efficient referral practices and novel ways of collaboration between GPs and mental health care professionals? Research question 3: Will the use of the BlueMood increase GPs' coping skills in treating patients with mental health problems?

在斯堪的纳维亚地区的全科医疗（General Practice）中，三分之一的门诊就诊源于心理健康问题。众多全科医师（General Practitioners, GPs）难以诊疗精神疾病患者。专科心理健康医疗服务面临大量质量参差不齐的转诊病例，精神专科医疗服务供给不足，患者需等待3至6个月方能获得专科治疗。此类等待时长往往会加重患者的病情症状。为解决全科医师诊疗水平参差不齐以及转诊等待时长过长的问题，我们需要创新患者诊疗方案，同时更高效地利用专科医疗领域的有限资源。在挪威北部，32%的人口居住在农村地区，每千人拥有0.59名心理师；而在奥斯陆与阿克什胡斯的城区，这一比例为每千人1.11名。前往区域医院的路途遥远、候诊队列更长，加之精神专科医师数量匮乏，进一步加剧了患者的诊疗困境。这一情况同样存在于其他斯堪的纳维亚国家的诸多农村地区。本项目对一套经充分验证的现有心理健康问题互联网自助项目（Internet-based self-help programme）进行小幅改良并应用，同时结合全科医师门诊服务，以此探索患者、全科医师与专科心理健康医疗从业者之间协作的创新路径。本项目旨在实现更高效、更优质的患者诊疗服务，优化向专科医疗的转诊流程，并确保患者从专科医疗向全科医疗的安全过渡。研究问题1：应用互联网自助项目BlueMood（Internet-based self-help programme BlueMood），能否建立患者与全科医师的协作新模式，并改善抑郁求助患者的诊断与治疗效果？研究问题2：在全科医疗场景中应用BlueMood，能否实现更高效的转诊流程，并开辟全科医师与心理健康医疗从业者之间的协作新路径？研究问题3：应用BlueMood能否提升全科医师诊疗心理健康问题患者的临床应对能力？