1. MasterMind in a nutshell
Claus Duedal Pedersen
Coordinator
Region of Southen Denmark

2. Agenda Introduction to MasterMind The objectives of the project
What did we do during those three years?
Some interesting results
Next steps

3. 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
14 m € budget (50% EU funding)

4. 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)

5. Objectives
Upscaling the ICT-based mental health care services (in regions/countries where these have already been 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

6. 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

7. 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
When we look on the characteristics of the chosen cCBT solutions at the different wave one trial sites, then we see, that
They arre all based on CBT
Functionally equivalent,
But are also fitted to the spceific requirement of the local helth care sstem annd thyus differ in their characteirstigc
NEED TO ADAPT SPECIFVALLY RELEVANT

8. cCBT solution characteristics: duration of treatment
Ranging from 5-25 sessions:
NST 5
RSD
6+2
GGZ InGeest
(primary care)
NHS24 10
Schoen
25 Sessions
16-20
(secondary care)
Schoen
(primary
Care)
For example ,NST in norwways applies a very low threshold solution, with only 5 sessions, whereas the Schoen clinics decided, that a 25 session solution has the highest potential within the current German health care system, as psychotherapy is usually delivered in at least 25 sesssion in Germany, and choosing the same amount of sessions for cCBT allows them to stay within the current legal regularies and thus speed up the implementation processs. 8 8

9. cCBT solution characteristics: support by a therapist
Form and intensity of support vary, from pure self-help to 25 hours of video-based therapy sessions.
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
Also
the ammount of support within the different programs vary quite substantially, ranging from pure self-help treatment
To 25 hours of
THINKKING ABOUT A WAY HOW TO PRESENT THIS A A STRENGHTS
1NST 2NHS24 3RSD 4GGZ InGeest 5Schoen

10. 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.

11. ccVC Services in Greenland
Room/setting designed specific for televideo conversations/therapy

12. What did we do during those three years?
Implemented services
Recruited patients
Collected data and evaluated
Exchanged knowledge and ideas
Communicated to professionals, citizens, researchers, and decisions makers
Planned further deployment

13. Implementation status✔
All trial sites are up and running

14. Evaluation of the services
Generic protocol following the MAST framework, including quantitative and qualitative data
Central database in Veneto
Focus on data management and quality assurance of data
Evaluation team
Data sharing agreement

15. Elements in MAST 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

16. Patient inclusion Target 5203 >> Included 11573

17. Exchange of knowledge Market place between 1st and 2nd wave cCBT.
Advisory Boards
Committed Regions
Workshop on ccVC
Uptake Seminar
EIPonAHA

18. Pens w. QR
Bags &
sticky notes
Postcards
Website
Roll-ups
Blog
Twitter
Poster
Leaflets

19. 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

20. Interesting results - cCBT
First wave:
30% of patients experienced a reduction in depressive symptoms, 16,6% in one and 12,4% in two categories. 12,1% deteriorated and 58,8% showed no change.
Second wave:
There is a decrease in both severe and very severe symptoms (respectively, 16.2% to 5.9% and 3.4% to 1.3%).
The number of patients with no symptoms by the end of the treatment was 32,3%

21. 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%.

22. 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

23. Cost - efficiency

24. Policy Policy influencing MasterMind MasterMind influencing policy
Show case
Evidence
Knowledge
Policy influencing MasterMind
Roll-out strategies
Demand for equal access
Reimbursement

25. MasterMind has supported the market

26. Stimulated a change in reimbursement systems

27. 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

28. Expansion paths for the MasterMind services
Number of patients
IT platforms
Organisation types
Clinical services

29. Yes, we did it!