Samhandling om pasienter med alvorlige psykiske problemer i allmennpraksis.

Abstract

Key messages The Norwegian Knowledge Centre for the Health Services (NOKC) was asked to perform a systematic review of effects of enhanced collaboration initiatives to improve the management of serious mental illness in primary care settings. The request came in autumn 2006 from the Norwegian Directorate for Health and Social Affairs in autumn 2006. The review was conducted by NOKC staff as well as a group of experts from the field. We searched electronic databases: EPOC, Medline, Psych info, Cochrane Library and EMBASE. We selected 19 studies, nine systematic reviews and ten primary studies. Outcomes relating to changes in process of care and patient-related outcome of treatment were sought together with costs and cost- effectiveness data. Methodological details and outcomes were extracted and checked by two reviewers. Most primary studies were conducted in the US primary health-care system, often in Health Maintenance Organizations (HMOs) or at university clinics. We did not find any Norwegian or Nordic effect studies which satisfied our inclusion criteria. A narrative synthesis was conducted. Multifaceted collaborative care treatment for major depression or/and anxiety disorders which combine educative and organizational initiatives improve patient outcomes and increase the quality of treatment compare to usual care. The intervention group had greater reduction in symptoms and remission rates along with better adherence to treatment. The effect size was moderate. Following factors seem vital for the effect: integration of collaborative care initiatives at all organizational levels, coordinate and patient-focused health services, integrated specialist mental health care in primary care, clinician and patient education, active monitoring of patients with feedback to primary care physician. Collaborative care across organizational levels and professions seems to increase total costs for health services and to consume more resources. Transferability of these models of collaborative care in the Norwegian health care system has to be evaluated from case to case. We did not identify any effect studies of collaboration initiatives between general practitioner and professions outside the health care system. There is a sparse evi7 For ord dence for the effect of collaborative treatment care for patients with schizophrenia, psychosis or other personality and behavioral disorders.