Web-based shared care for GPs and mental health services in Sydney

The intervention is an electronic version of a shared care plan (e-shared plan) using Inca from the Precedence Software Company. Inca is commercially available software that integrates with most general practice medical record software in Australia (e.g.: Best Practice, Medical Director) to create electronic shared care plans (“e-care plans”) that can be shared with other clinicians and consumers. An Inca template for an e-care plan for consumers of adult community mental health services (MHSs) in Sydney Local Health District (SLHD) was developed to replace the shared care checklist used by SLHD. This is a static document that has been installed in the GP’s electronic medical record system by the primary health network. It can be viewed onscreen or printed and used as a paper form. This checklist was slightly revised for the trial to qualify as a shared care plan so the e-shared plan and shared care document are identical apart from the mode (electronic and interactive or static document). Both the electronic (intervention) and the document (comparison) versions of the care plan specify goals and tasks for the GP, mental health service and consumers, their frequency, and who is responsible for their completion. The care plan tracks the tasks and provides prompts for overdue tasks. Tasks for the GP could be “review blood tests”; for the MHS could be “arrange for consumer to have a blood test”; for consumer could be “reduce smoking ”. The study is a pragmatic cluster randomised trial with the unit of randomisation being four of the five Adult Community Mental Health 'Core' Teams in Sydney Local Health District (SLHD). Pairs of teams (matched by service type and consumer population) randomised to early or late intervention over 12 months. Training will be provided by the research team and an Inca specialist from Precedence Software Company to mental health service clinicians and GPs. - Mental health service clinicians: 1-hour online workshop on shared care and the use of the shared care tool will be provided to 4 groups 2-4 weeks prior to the commencement of the intervention. A recorded training session will be available for new staff or staff who missed the training. A certificate of attendance will be provided. - GPs in the intervention group: a one-on-one, 1 hour online or face-to-face training session will be provided on the use of the e-shared plan, including how to support consumers to use the tool immediately after the GPs consent to the study. Screenshots of how to use the e-shared care plan will be available as part of a training package. - Ongoing support for all clinicians in using the Inca e-shared plan will be provided by Precedence via telephone, live chat or email. Recruitment and establishment of the care plan involves the following steps: - MHS clinicians enrol consumers in shared care and organise an appointment (face-face or telehealth) with the consumer’s GP to initiate shared care. - Precedence will install Inca software on the GPs’ computers remotely. The installation could take 10 -30 minutes. - Precedence and a research team member will show the GP how to create a care plan template and how to add new care team members including MHS clinicians. - The MHS clinician and consumer (with carer or support worker if applicable) attend an appointment with the GP to set up the e-shared plan. It is anticipated that the initial appointment to establish the e-shared care plan in general practice will take 30 minutes. - After initiating the care plan, the GP will be alerted to the care plan each time the patient’s medical record is opened. The GP will then click on the link to take them into the care plan. - After the care plan is initiated by the GP, the MHS will receive an email notifying them of the care plan and providing log in information for them to access and edit the care plan as appropriate. - Consumers will receive log-in information to access the online version of Inca to view their own shared care plan and if accessing a computer is an issue, a printed copy of the care plan will be provided by the GP or/and MHS clinician. - Participants will continue to see their GP or mental health provider separately or together as necessary. - Appointments for shared care with the GP will be determined from the frequency that tasks are to be performed. These will be at least annually for the GP. Mental health services have equipment to use Inca enable video conferences / telehealth with GPs and consumers. GPs can tailor the e-shared plan for each patient. For example, a patient task could be added, the smoking section could be deleted if the patient does not smoke. Measures of intervention fidelity include: - the proportion of consumers whose e-care plan is accessed by the GP and mental health team - consistency of use of the e-care plans across sites.