Original Title: Modelos e intervenciones de colaboración entre Atención Primaria y Salud Mental en la atención a los pacientes diagnosticados de depresión: resultados de una meta-revisión

Authors' objectives: To review the information available in the scientific literature concerning the main characteristics and efficiency of the different collaborative models and interventions between primary care (PC) and mental health (MH) in the care of patients diagnosed with depression in order to identify possible measures to improve care, applicable to our environment.

Authors' results and conclusions: Sixty-nine secondary studies were identified and assessed. Most came from the United States and to a lesser extent from the United Kingdom, Australia, Canada and other countries. Three classificatory schemes were analysed, with 6 main models: stepped care, consultation-liaison, disease management and case management, quality improvement programmes, chronic care model (CCM) and collaborative care models, and 7 interventions: training of PC professionals, screening activities, dissemination of clinical practice guidelines (CPGs), information systems, telephone care, tele-psychiatry and the incorporation of new professionals or new roles. Overlapping between models is very frequent without any linear correspondence between interventions and models. There is a great deal of variability according to contexts and there are major methodological shortcomings in a large number of studies. Heterogeneity and a lack of information about types of depression and the target populations for interventions were observed. The quality of the evidence concerning the effectiveness of different models and interventions is mainly low or doubtful. The most effective collaboration experiments are those that include interventions designed to favour the responsibility of the different professionals in the treatment and monitoring of the patient, the redesign and support maintained in management, and shared information and communications. The effects of the training of PC professionals, the dissemination of CPGs and the incorporation of new professionals are more favourable when they form part of the aforementioned models or integrating strategies. The traditional systematic review model as an evaluation tool has a number of limitations as a result of the complex nature of the PC-MH collaboration strategies and interventions in the care of depression. CONCLUSIONS The quality of the evidence published on the effectiveness of collaboration models and interventions is generally low or doubtful and the less well-defined the components, processes and the circumstances of the implementation are, the lower their significance and applicability. Faced with the lack of applicable models, assessable PC-MH collaboration strategies appropriate for each context should be promoted. Such collaboration strategies require improvement and evaluation designs that take into account the integration of interventions and functions of proven effectiveness, the fact that they are long-term process and the particular nature of depression as a health problem. The traditional approaches and tools used to review and evaluate PC-MH collaboration strategies for the care of depression must be adapted to the fact that it is a condition that requires complex interventions.

Authors' methods: Meta-review of secondary studies published between 2001 and 2010 on the effectiveness of the PCMH collaboration to improve the care of depression. During the first stage, a search was made of studies published in the bibliographical databases: MEDLINE, PsycINFO, Embase, IME, LILACS, IBECS and The Cochrane Library. Searches were made in English, Spanish and Portuguese on the models of coordination, interrelationship, integration or collaboration between levels of care in the attention given to persons diagnosed with depression. Studies referring to specific aspects of the diagnostic or treatment process were excluded. Through successive screenings, duplicated articles or those that did not correspond to the aim of the review were eliminated and those found by means of manual searches were included. During the second stage, the results were analysed and the quality of the secondary studies available in complete texts was assessed. The AMSTAR tool was used in articles corresponding to reviews. Finally, an initial synthesis was made of the evidence relating to the different models of collaboration and interventions for which both summary tables were drawn up in accordance with 4 levels of quality of the evidence of improvement. This process was carried out independently by three of the researchers, a consensus was reached on any discrepancies and the final results were discussed with the remaining members of the research team.

Project Status: Completed

Year Published: 2013

URL for published report: https://www.euskadi.eus/contenidos/informacion/2013_osteba_publicacion/es_def/adjuntos/Informe%20D-13-13%20modelos%20e%20intervenciones.pdf

English language abstract: An English language summary is available

Publication Type: Rapid Review

Country: Spain

Organisation Name: Basque Office for Health Technology Assessment

Contact Address: C/ Donostia – San Sebastián, 1 (Edificio Lakua II, 4ª planta) 01010 Vitoria - Gasteiz

Contact Name: Lorea Galnares-Cordero

Contact Email: lgalnares@bioef.eus

Copyright: <p>Osteba (Basque Office for Health Technology Assessment) Health Department of the Basque Government</p>