E-COMPARED is the first nationwide project in Poland offering blended treatment for depression. Therefore, when starting the trial we had to undertake additional actions aiming to inform stakeholders and mental health specialists about the effectiveness of blended treatment. We launched a media campaign and organized stakeholder meetings to present evidence supporting the effectiveness of blended treatment for depression.
Awareness of available non-pharmacological options for depression treatment is still low in Poland. Moreover, psychotherapy in general is perceived as more time consuming and more costly form of treatment, compared to pharmacology. Additionally, the national healthcare insurance company (NFZ) does not offer an easy access to the reimbursement of mental healthcare expenses.
During the recruitment phase of the project, we observed that many patients seeked professional help when their condition was already severe. We had to exclude about 30% of patients and offer them another form of treatment due to high risk of suicide. It also appeared that some of the patients were interested only in participating in the blended treatment arm of the trial, and they did not accept the possibility that they might be randomly assigned to the treatment as usual. They perceived treatment as usual as more effortful and time-consuming than blended treatment.
Therapists struggle with high costs of their services and charge patients directly for the treatment. Complex bureaucratic procedures and low reimbursement rates proposed by the NFZ are considered discouraging and many therapists are disinclined to sign a contract with the NFZ. Moreover, throughout the project we observed that psychotherapists perceive recruitment procedure as too complicated and even though we trained them and offered support during the project, they still found the procedure demanding both for them and the patients.
Study recruitment in Poland
Currently, we undertake many activities in order to intensify recruitment process. As of March 2016, 31 patients were enrolled as participants and 32 collaborating cognitive behavioral (CBT) psychotherapists were engaged in recruiting patients and delivering treatment. Those mental health specialists are collaborating with the SWPS University’s CBT training centers located in five cities: Warsaw, Sopot, Poznan, Katowice, and Wroclaw. Due to a low number of enrolled patients we prepared additional materials (e.g., leaflets, posters, visual aids to be used on websites, such as video clips) to facilitate recruitment. We intensified contacts with collaborating therapists offering them additional support in recruiting more patients. To increase psychotherapists’ engagement, we maintain regular phone and e-mail communication with them. We have also launched the newsletter service to share good practice and information about the project.
We plan to recruit therapists from other regions of Poland to expand the availability of the depression treatment within E-COMPARED project. To achieve this goal we reached the network of the CBT psychotherapists associated with the Polish Society for Cognitive and Behavioral Therapy. We are also planning to inform patients’ societies about the project and collaborate with them to increase patients’ awareness that evidence-based treatment delivered through the E-COMPARED project is available for them.
First experiences with Moodbuster
By now, we have made very good experiences with Moodbuster, the program that is used in Poland to blend face-to-face treatment. To this date we have 15 patients in blended condition. We have encountered only minor technical problems, but we were able to resolve them easily. We created a dedicated e-mail address for Polish patients to support them, but so far we didn’t receive any complaints or questions. This is due to the fact that the platform is easy to use and that our therapists are well-trained and able to help their patients with minor technical problems.
Katarzyna Żukowska, MSc
SWPS Uniwersytet Humanistycznospołeczny
Univeristy of Social Sciences and Humanities