Monday, 6 April 2015

Mental health: services integration is the key

A systematic review accompanied by a meta-analysis shows that the model Collaborative Chronic Care Models (CCMs), designed by Edward Wagner for chronic patients, offers a robust framework for service integration and may improve health outcomes in psychiatric patients, both mentally and physically.

Let's look in the following table at the components that the authors have used to identify projects that were based on CCMs model:

The drastic reduction of long-term institutionalization of psychiatric patients in the last 30 years has allowed patients to live in the community. This has forced the health system to deploy alternative primary care services and has also forced the general hospitals to get involved. But now the models for mental health care are affected by the problems of coordination between levels similarly to what happens to the other specialties and for this reason, I believe that the study of Woltmann and collaborators is relevant because it warns that the providers of psychiatric programs that know how to set up comprehensive and integrated services will provide more value to the health of people.

Care Delivery Value Chains for depression

If you notice, most clinical trials from the Woltmann article, in particular 40 out of 57, are specific to depression, not surprisingly this is a very common condition and has a lot of impact on the case-mix of primary care. And so I want to finish the post remarking that Care Delivery Value Chains for depression introduce many CCM elements in an area bordering levels:
  • Coordination of care objectives
  • Treatment Guidelines (consensual clinical practice guidelines)
  • Involvement of psychiatrists in consulting GPs
  • Shared clinical record
  • Evaluation of results
  • Specific training based on the evaluation

If you want people suffering from mental health problems to decrease the implicit stigma of the disease, it is necessary to live in a community setting, but this is not possible if the health and social systems do not deploy adequate resources and they also need to learn to coordinate and integrate them with programs that provide better quality of life.

A thank you to Dr. Luis Miguel Martin, Director of Community Care Process of INAD of Parc de Salut Mar in Barcelona, for the documentation he provided for this post.

Jordi Varela

No comments:

Post a Comment