Bridging the mental health treatment gap: effects of a collaborative care intervention (matrix support) in the detection and treatment of mental disorders in a Brazilian city

Abstract

ObjectiveTo analyse temporal trends in diagnosis and treatment of mental disorders in primary care following implementation of a collaborative care intervention (matrix support).DesignDynamic cohort design with retrospective time-series analysis. Structured secondary data on medical visits to general practitioners of all study clinics were extracted from the municipal electronic records database. Annual changes in the odds of mental disorders diagnoses and antidepressants prescriptions were estimated by multiple logistic regression at visit and patient-year levels with diagnoses or prescriptions as outcomes. Annual changes during two distinct stages of the intervention (stage 1 when it was restricted to mental health (2005–2009), and stage 2 when it was expanded to other areas (2010–2015)) were compared by adding year–period interaction terms to each model.Setting49 primary care clinics in the city of Florianópolis, Brazil.ParticipantsAll adults attending primary care clinics of the study setting between 2005 and 2015.Results3 131 983 visits representing 322 100 patients were analysed. At visit level, the odds of mental disorder diagnosis increased by 13% per year during stage 1 (OR 1.13, 95% CI 1.11 to 1.14, p<0.001) and decreased by 5% thereafter (OR 0.95, 95% CI 0.94 to 0.95, p<0.001). The odds of incident mental disorder diagnoses decreased by 1% per year during stage 1 (OR 0.99, 95% CI 0.98 to 1.00, p=0.012) and decreased by 7% per year during stage 2 (OR 0.93, 95% CI 0.92 to 0.93, p<0.001). The odds of antidepressant prescriptions in patients with a mental disorder diagnosis increased by 7% per year during stage 1 (OR 1.07, 95% CI 1.05 to 1.20, p<0.001); this was driven by selective serotonin reuptake inhibitor prescriptions which increased 14% per year during stage 1 (OR 1.14, 95% CI 1.12 to 1.18, p<0.001) and 9% during stage 2 (OR 1.09, 95% CI 1.08 to 1.10, p<0.001). The odds of incident antidepressant prescriptions did not increase during stage 1 (OR 1.00, 95% CI 0.97 to 1.02, p=0.665) and increased by 3% during stage 2 (OR 1.03, 95% CI 1.00 to 1.04, p<0.001). Changes per year were all significantly greater during stage 1 than stage 2 (p values for interaction terms <0.05), except for antidepressant prescriptions during visits (p=0.172).ConclusionThe matrix support intervention may increase diagnosis and treatment of mental disorders when inter-professional collaboration is adequately supported. Competing demands to the primary care teams can subsequently reduce these effects. Future studies should assess clinical outcomes and identify active components and factors associated with successful implementation.

Effect of implementation of mental health services within primary care on GP detection and treatment of mental disorders in Israel

“…This was true even if the GP did not specifically define the disorder as depression or anxiety, as cases in this sample had mainly depressive or anxiety disorders [ 2 ]. Similar results were observed in the time series study [ 17 ] that showed increased prescription of antidepressants in medical records during the time of mental health collaborative care. Among GP-diagnosed depressive disorder patients, there was no increase in the already relatively high use of antidepressants before program implementation compared to rates reported in other centers [ 1 ].…”

“…Analysis of these models primarily showed the symptomatic outcome of patients treated in these services, which has often been positive [ 14 – 16 ]. Only one time series study reported the effect of the program on GP diagnosis, as recorded in medical records, but without parallel objective assessment of prevalence at the time of the study [ 17 ].…”

Management of Dental Patients With Mental Health Problems in Special Care Dentistry: A Practical Algorithm

“…The liaison between psychiatrists and dentists is necessary and consultation liaison models have to be created for treating patients with mental health problems. Hence, the proposed framework of Psychiatric Dental Consultation Liaison (PDCL) services is attaining success and popularity for a confident approach towards oral care delivery among dentists [22][23].…”

Effectiveness of Agreement Criteria and Flows of Collaborative Care in Primary Mental Health Care in Brazil

“…Gaps in collaborative mental health care can be filled through a positive association. For instance, there is a protective factor between the implementation of matrix support and the improvement in the detection and treatment of mental disorders in primary care, suggesting effects of this primary mental health care are favored by intensifying local organizational support for clinical integration among RAPS workers, including those at the Primary Care point [ 39 ].…”