Implementation of eHealth

services for depression

treatment across EU -

Experiences from the large

scale EU project

MasterMind

MasterMind introduction

Claus Duedal Pedersen

Coordinator

Region of Southen Denmark

Agenda

Introduction to MasterMind

The objectives of the project

Some interesting results

Status 2019

Funded by CIP-ICT-PSP-2013-7

Competitiveness and Innovation

Framework Programme

Information and Communication Technology

Policy Support Programme

Call 7, launched in January 2013

Focus on implementation

MasterMind:14 m € budget (50% EU funding)

MasterMind in a nutshell

Target population Adults suffering from mild, medium, or severe

depression

Both inpatients and outpatients

Two different services computerised Cognitive Behavioural Therapy

(cCBT)

Videoconference for Collaborative care and

treatment (ccVC)

Upscaling the ICT-based mental health care services (in regions/countries where these have been already successfully piloted)

Triggering the uptake of the services (in regions/countries new to ICT-based mental health care services)

Demonstrating clinical outcomes and economic effectiveness

Optimising the organisation of mental health services

Increasing the equal access to mental health care

Ensuring that the services are safe for patients and do not increase the incidence of adverse events

Objectives

Goals of MasterMind

Implement the cCBT and ccVC services in

15 European regions

Two-wave implementation for cCBT

services

Systematic evaluation based on the MAST

framework

Provide the services to at least 5230

patients

cCBT solutions - characteristics

…are based on cognitive behavioural

therapy (CBT)

…are functionally equivalent

…are fitted to the specific requirements of

the local health care system and thus differ

in their characteristics

NST

5

RSD

6+2

GGZ

InGeest

(primary

care) NHS24

10

Schoen

25 Sessions 16-20

GGZ

InGeest

(secondary

care)

cCBT solution characteristics:

duration of treatment

Ranging from 5-25 sessions:

Schoen (primary

Care)

8 8

Form and intensity of support vary, from pure self-help to

25 hours of video-based therapy sessions.

1NST 2NHS24 3RSD 4GGZ InGeest 5Schoen

Video-based synchronous support 5

Blended care consisting of

face-to-face sessions and

cCBT + video-support4

Written online support with continues

communication possibility3,(4) 5

Telephone and/or mail

support1

Self-help1,2

cCBT solution characteristics:

support by a therapist

ccVC services Group A is collaborative care between specialist and GP

without patient. The specialist guides the GP in the use of cCBT, or together they assess a patient’s medication, or plan treatment.

Group B is collaborative care between specialist and GP where the patient can be present. The purpose of the meetings can be the same as for group A

Group C is follow-up or out-patient care with the patient at home. The healthcare worker (GP or specialist) communicates with the patient, who is at home.

Group D is acute care. This is video conference from the

acute ward to a specialist. Together with the patient, they make a treatment plan.

Room/setting designed specific for televideo conversations/therapy

ccVC Services in Greenland

Exchange of knowledge

Market place

between 1st and 2nd

wave cCBT.

Advisory Boards

Committed Regions

Workshop on ccVC

Uptake Seminar

EIPonAHA

Preceding assessment:

• International/national/regional/local level?

• Relevant alternatives?

Multidisciplinary assessment (domains):

1. Health problem and characteristics of the application

2. Safety

3. Clinical effectiveness

4. Patient perspectives

5. Economic aspects

6. Organisational aspects

7. Socio-cultural, ethical and legal aspects

Transferability

assessment:

• Cross-border

• Scalability

• Generalisability

Elements in MAST

Patient inclusion Target 5203 >> Included 11573

0

2000

4000

6000

8000

10000

12000

14000

Status 1st of February 2017

Target number Current total

Interesting results

MasterMind services have created access

to eMental health for patients where there

is no alternative

More patients had severe or very severe

symptoms than expected (57% in 1st wave

and 20% in 2nd wave)

Is it safe? - less than 0,1% of the patients

attempted suicide during treatment

Interesting results - ccVC

There is a decrease in both severe and very

severe symptoms (respectively, 16.5% to

9.8% and 3.8% to 0.9%).

The number of patients with no symptoms

has increased from 2.6% to 32.5%.

Interesting results

Are patients and health care professionals satisfied with the cCBT services?

69% in the first wave and 76 % of the second wave patients report to be satisfied with the treatment. However, there are large variations between the sites from 17% to 92%

62,6% of the healthcare professionals would say that they are generally satisfied with service. Again there is a large variation from 44 – 100% between sites

Budget Impact

Ara

gon

Bad

alo

na

Gal

icia

Pie

mo

nte

Trev

iso

Sco

tlan

d

Net

her

lan

ds

Ger

man

y

No. patients 32 74 37 116 92 5371 247 280

Reduction symptoms in 1 level 37 57 41 91 106 933 283 280

Cost pr. Reduction € 623 1.917 1.032 428 165 48 385 843

MasterMind has supported the

market

Lessons learned for

implementation

Engaging healthcare professionals

A well-functioning technical solution

A clear management strategy

Sufficient training

National guidelines are needed e.g. with

respect to legal aspects

Information to patients and partners is key

Reimbursement structures are a key issue

Expansion paths for the

MasterMind services

Organisation types IT platforms

Number of patients

Clinical services

Status January 2019 • Denmark: The regional solution “Internetpsykiatrien” have been up scaled

to a national service.

• Scotland: Full national rollout of cCBT was completed in July 2018.

• Turkey: Top Sende was successful as a pilot application. Service continues in a new research project.

• Basque Country: cCBT and ccVC is included in Osakidetza's services

• Wales: The service is currently being upscaled across Powys Teaching Health Board

• Catalonia: Service have been running snice 2018 in Badalona: including more than 300 professionals

• Aragon: Running in daily operation, new version just installed

• Germany: Running as a daily service in Shöne Clinic and included in the reimbursement system

• Italy: Running in daily operation in ALSTO3 provide though a GP network.

CIP-ICT-PSP-2013-7

MasterMind GA no. 621000

Yes, we did it!