We read with great interest the article by Gidding et al about the effects of the e-tool PsyScan on patients with psychological problems in general practice.1 We agree that a tool is needed that can support management of these patients and we appreciate the effort in developing the PsyScan e-tool. However, we would like to discuss a few issues.
First, we approve of the randomisation method the authors used; however, patients were randomised before signing the detailed informed consent. We wonder if the initial assignment of patients in the intervention or control group may have influenced the decision to participate in the study. Was the number of participants who were excluded because they were not willing to sign the detailed consent similar in the intervention and control group? Participants who were assigned to the control group might be more likely to withdraw consent, because they could feel that participation had fewer benefits.
Second, participants in the intervention group first had to complete the three-question distress screener. The score of this questionnaire was crucial for the advice and treatment the patients received. The validation of the three-question distress screener was investigated by Braam et al,2 although this was evaluated in a population of employees and not in the general practice population. What were the authors’ considerations for specifically choosing this questionnaire?
Third, the aim of the e-tool was to achieve more appropriate management of patients with psychological problems and provide an improvement of symptoms. The PsyScan resulted in a significant reduction of patient-reported symptoms, although the number of the different GPs’ actions were quite similar in both groups, and most of the differences were not significant. In our opinion, these small differences may not be clinically relevant. Our question is: did the authors consider another working mechanism that can explain the shown symptom reduction after 12 months?
Fourth, we wonder if the authors could explain why, after 3 and 6 months, there were no significant differences, whereas after 12 months’ follow-up the difference in effects was present. Do the authors plan a longer-term follow-up, for example, after 18 or 24 months?
In conclusion, the PsyScan is a relevant tool for the GP and results in a better understanding between patient and doctor.
- © British Journal of General Practice 2018
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