Evaluation of a collaborative care model for integrated primary care of common mental disorders comorbid with chronic conditions in South Africa

BMC Psychiatry

Emily C. Baron¹  Crick Lund¹  Arvin Bhana²  One Selohilwe²  Inge Petersen²  Tasneem Kathree²  Lara R. Fairall³  Sujit D. Rathod⁴ 

[1] Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town;Centre for Rural Health, Howard College, University of KwaZulu-Natal;Knowledge Translation Unit, University of Cape Town;London School of Hygiene and Tropical Medicine;

关键词: Common mental disorders;    Task sharing;    Collaborative care;    Chronic care;    Lay counsellors;    South Africa;   

DOI  :  10.1186/s12888-019-2081-z

来源: DOAJ

【 摘 要 】

Abstract Background The rise in multimorbid chronic conditions in South Africa, large treatment gap for common mental disorders (CMDs) and shortage of mental health specialists demands a task sharing approach to chronic disease management that includes treatment for co-existing CMDs to improve health outcomes. The aim of this study was thus to evaluate a task shared integrated collaborative care package of care for chronic patients with co-existing depressive and alcohol use disorder (AUD) symptoms. Methods The complex intervention strengthened capacity of primary care nurse practitioners to identify, diagnose and review symptoms of CMDs among chronic care patients; and implemented a stepped up referral system, that included clinic-based psychosocial lay counsellors, doctors and mental health specialists. Under real world conditions, in four PHC facilities, a repeat cross-sectional Facility Detection Survey (FDS) assessed changes in capacity of nurses to correctly detect CMDs in 1310 patients before implementation and 1246 patients following implementation of the intervention at 12 months; and a non-randomly assigned comparison group cohort study comprising 373 screen positive patients with depressive symptoms using the Patient Health Questionnaire-9 (PHQ9) at baseline, evaluated responses of patients correctly identified and referred for treatment (intervention arm) or not identified and referred (control arm) at three and 12 months. Results The FDS showed a significant increase in the identification of depression and AUD from pre-implementation to 12-month post-implementation. Depression: (5.8 to 16.4%) 95% CI [2.9, 19.1]); AUD: (0 to 13.8%) 95% CI [0.6–24.9]. In the comparison group cohort study, patients with depressive symptoms having more than a 50% reduction in PHQ-9 scores were greater in the treatment group (n = 69, 55.2%) compared to the comparison group (n = 49, 23.4%) at 3 months (RR = 2.10, p < 0.001); and 12 months follow-up (intervention: n = 57, 47.9%; comparison: n = 60, 30.8%; RR = 1.52, p = 0.006). Remission (PHQ-9 ≤ 5) was greater in the intervention group (n = 32, 26.9%) than comparison group (n = 33, 16.9%) at 12 months (RR = 1.72, p = 0.016). Conclusion A task shared collaborative stepped care model can improve detection of CMDs and reduce depressive symptoms among patients with chronic conditions under real world conditions.

【 授权许可】

Unknown