Shared Care and Usual Health Care for Mental and Comorbid Health Problems. A Cluster Randomized Trial
试验速览
- 阶段
- 不适用
- 状态
- 已完成
- 发起方
- 入组人数
- 19,000
- 主要终点
- Referrals from GPs to mental health outpatient clinics
研究概览
简要总结
The aim is to study the impact on patients and health care by an adaption of the Hamilton Family Health Team model of shared care between general practitioners (GPs), mental health services and other primary or specialized services. The study is done at six GP centers with 30 GPs in three boroughs in Oslo, Norway.
At each GP center with shared care one clinical psychologist from a CMHC works two and a half day a week and a psychiatrist 1-2 hours a week. They are available for the GPs for discussions, and they give assessment and brief treatment as requested by the GPs. Other primary health and social care and other specialized mental health or substance addiction services are consulted according to needs of the patients.
The study is a cluster randomized controlled study of GP patients and their health care in GP centers with shared care (experimental group) compared with usual health care in other GP centers (control group). In each of three boroughs one GP center is randomized to shared care for 18 months while another center continues with usual health care.
Register data on patients and services are extracted for 12 months (T0) before implementation of shared care and for 12 months (T1) with shared care after 6 months implementation. The register data on patients and health care are extracted from the GP patient records, mental health and substance abuse services, and NAV (social/welfare services). The cohorts at T0 and T2 include all patients 16-65 years old seen by the GPs.
Patient-reported mental health, functional impairment due to health problems, overall quality of life and satisfaction with health services are studied for a sub-sample of the register cohort at both T0 and T1.
A qualitative sub-study of experiences with collaboration, the shared care model, implementation of the model, facilitators and barriers is done at the end of the 18 months period of shared care. The informants include patients, GPs and coworkers, and managers and professionals involved with shared care.
The study protocol was approved by the regional and national committees on medical and health research, as well as by the data protection officer at health trust.
Progress and status are described in Detailed description. Data analysis starts in September 2018.
详细描述
BACKGROUND
There have been various forms of collaboration in Norway between community mental health centres (CMHCs), GPs and primary health and social care. But with a lack of research on such models, there is little knowledge on whether they contribute to better health care, outcome and satisfaction, e.g. for the large group of patients with moderately severe mental and comorbid health problems mostly seen by GPs. There is a great need for clearly defined collaboration models and for research-based knowledge of their feasibility and impact in the context of the Norwegian health services.
Reviews of studies on collaboration show inconsistent results, including insufficient evidence to demonstrate significant benefits from shared care (Smith 2009), modest reductions in primary care consultations and mental health referrals (Harkness 2009), partly improved depression management (Butler 2011), and research primarily on simpler models of collaboration between two professionals (Hviding et al. 2008, Craven et al 2006).
The Family Health Teams model developed in Hamilton, Canada, is a promising model of shared care (Kates 2011a, 2011b). It is built around GP practices. Each team include one or more GPs, nurses, mental health counsellors, a visiting consultant psychiatrist, and some other part-time staff (pharmacist, nutritionist, physiotherapist, occupational therapist). The model has increased access to care for persons with mental health and addiction problems, reduced waiting time, reduced referrals to outpatient mental health services, increased patient satisfaction, improved patient health, improved communication and co-ordination, and increased GPs' confidence and skills in treating mental health problems.
CONTEXT
研究设计
- 研究类型
- Observational
- 观察模型
- Other
- 时间视角
- Other
入排标准
- 年龄范围
- 16 Years 至 65 Years（Child, Adult, Older Adult）
- 性别
- All
- 接受健康志愿者
- 否
入选标准
- •Seen by a GP during the 12 months for extracted data on all contact
排除标准
- •No exclusion criteria
结局指标
主要结局
Referrals from GPs to mental health outpatient clinics
时间窗: 12 months
Referrals from GPs to mental health outpatient clinics during the period for data extraction
次要结局
- Length of sick leave(12 months)
- Number of GP consultations(12 months)
- Number of outpatient consultations(12 months)
- Self-reported impairment in functioning due to health problems(2 weeks)
- Number of inpatient days(12 months)
- Referrals from GPs to mental health inpatient wards(12 months)
- Length of an inpatient stay(12 months)
- Type of health problem(12 months)
- The severity of psychiatric symptoms(12 months)
- Waiting time from the referral to the first consultation(12 months)
- Length of an outpatient treatment episode(12 months)
- The severity of impairment in functioning(12 months)
- Patient satisfaction with health services(2 weeks)
- Self-reported mental health problems(2 weeks)
- Overall quality of life (MANSA)(2 weeks)
研究者
Torleif Ruud
Senior Researcher, Professor emeritus
University Hospital, Akershus