Improving the time-efficiency of initial mental health assessment (triaging) using an online assessment tool followed by a clinical interview via phone: a randomised controlled trial
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Background
The need for time-efficient and accessible mental health assessment is a priority in the face of high demand, limited resources and a progressive increase in the percentage of adults experiencing high or very high levels of psychological distress. Although there is broader supportive evidence for using online assessment as a potential solution, there is relatively little evidence from randomised controlled trials.
Objective
To investigate whether patient online self-reported clinical information can save clinician time in subsequent mental health assessment via phone.
Methods
Patients referred to a public mental health service by general practitioners via fax during business hours between February 2020 and June 2022 were randomly allocated to either the intervention (self-reporting of clinical information followed by clinician assessment by phone) or control (clinician phone assessment as usual) arm. The time to complete the assessment (call duration) was the primary outcome measure.
Results
Out of 758 referrals assessed for eligibility, 377 (49.34%) entered the study and were randomised. Out of 184 referrals allocated to the intervention arm, the assessment was completed in 125, but only 81 were included in the analysis, mostly due to failure of clinicians to follow the protocol (completing the assessment without using self-reported data, likely due to inexperience with the novel process). Of 193 referrals allocated to the control arm, 135 completed the assessment and were included in the analysis. Average assessment completion time in the control arm was 25.19 min (standard deviation (SD) of 11.5 min) and 20.76 min (SD 7.49 min) in the intervention arm respectively, with a mean difference of 4.43 min (17.59% time reduction). When a mixed effects linear model was used to adjust for potential seasonal effect and correlation of outcome within clinicians, a statistically significant reduction of 3.29 min ( P = 0.016, 95% CI (5.85, 0.73)) was still demonstrated by using online assessment.
Conclusion
The use of online self-report clinical assessment by patients can save time to complete subsequent clinician assessment. Greater time-saving can be expected with better integration of this tool in workflow and increased clinician familiarity with using online self-reported data.
Trial registration
(registered retrospectively) Registry: Australian and New Zealand Clinical Trial Registry (ACTRN). Registration number: anzctr.org.au ACTRN12624001293550. Date of registration: 24/10/2024.
