Effectiveness of service linkages in primary mental health care: a narrative review part 1

Abstract

BackgroundWith the move to community care and increased involvement of generalist health care providers in mental health, the need for health service partnerships has been emphasised in mental health policy. Within existing health system structures the active strategies that facilitate effective partnership linkages are not clear. The objective of this study was to examine the evidence from peer reviewed literature regarding the effectiveness of service linkages in primary mental health care.MethodsA narrative and thematic review of English language papers published between 1998 and 2009. Studies of analytic, descriptive and qualitative designs from Australia, New Zealand, UK, Europe, USA and Canada were included. Data were extracted to examine what service linkages have been used in studies of collaboration in primary mental health care. Findings from the randomised trials were tabulated to show the proportion that demonstrated clinical, service delivery and economic benefits.ResultsA review of 119 studies found ten linkage types. Most studies used a combination of linkage types and so the 42 RCTs were grouped into four broad linkage categories for meaningful descriptive analysis of outcomes. Studies that used multiple linkage strategies from the suite of "direct collaborative activities" plus "agreed guidelines" plus "communication systems" showed positive clinical (81%), service (78%) and economic (75%) outcomes. Most evidence of effectiveness came from studies of depression. Long term benefits were attributed to medication concordance and the use of case managers with a professional background who received expert supervision. There were fewer randomised trials related to collaborative care of people with psychosis and there were almost none related to collaboration with the wider human service sectors. Because of the variability of study types we did not exclude on quality or attempt to weight findings according to power or effect size.ConclusionThere is strong evidence to support collaborative primary mental health care for people with depression when linkages involve "direct collaborative activity", plus "agreed guidelines" and "communication systems".

Strategies to facilitate integrated care for people with alcohol and other drug problems: a systematic review

“…While many of these have been identified as useful strategies in other health and social care contexts [12, 30, 43], our review highlights the way in which these manifest in the context of providing care to people with AOD problems. There are likely to be many more examples of integrated working practices and innovation in this area, but some may not have been documented, subjected to research or published in peer-reviewed journals.…”

Modelos de colaboración entre atención primaria y salud mental en la asistencia sanitaria a las personas con depresión: resultados principales y retos metodológicos de una meta-revisión sistemática

“…Los estu dios secundarios publicados más reciente mente reproducen su procedencia mayorita ria de EEUU 99106 y remarcan la importancia de las particularidades locales así como el carácter complejo de las iniciativas integra doras más efectivas 99,100 . El enfoque multi profesional en la atención al paciente, la necesidad de planes de gestión, el segui miento de los pacientes y la potenciación de la comunicación interprofesional parecen confirmarse como componentes clave de dichos modelos colaborativos 47,103 .…”

“…Por un lado, debería cuestionarse la difusión e importación mecánica de modelos de cola boración APSM en la atención a las perso nas con depresión sin analizar previamente las circunstancias y contextos donde se han desarrollado y se ha evaluado su efectivi dad. Y por otro, habría que tener en cuenta la deseable complementariedad de interven ciones diferentes, lo cual exige atender en su diseño y evaluación no solo al desarrollo efectivo de cada componente sino también a la propia gestión integradora 100,102 .…”

“…Otra de las limitaciones de las eva luaciones revisadas es la falta de manteni miento a largo plazo de las mejoras, resul tando excepcionales a partir del segundo año. Esta deficiencia, señalada también en publicaciones más recientes 100,102,103 , estaría condicionada en parte por su vinculación a investigaciones con recursos extra que tien den a desaparecer una vez finalizado el estu dio y, sobre todo, porque la sostenibilidad a largo plazo de las estrategias de colabora ción requiere la implicación mantenida tan to de la gestión como de los profesiona les 43,51,99,101 . Los retos no son fáciles de resolver.…”

Governance & evaluation of service networks as integrative structures in Australian primary health care

“…(1) Narrative review on the enablers of effective service linkages in primary mental health care [2,3]. Results:Effective service linkages were found across direct collaborative activities, agreed guidelines and communication systems.…”