Collaborative Care for Anxiety Disorders in Primary Care: a Systematic Review and Meta-Analysis

Muntingh, Anna; Feltz-Cornelis, C.M. van der; Marwijk, Harm Wj van; Spinhoven, Philip; Balkom, A.J.L.M. van

doi:10.1176/appi.focus.15303

Cited by 10 publications

(10 citation statements)

References 44 publications

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“…Healthcare professionals from multiple disciplines work together to coordinate care and treat patients. The Collaborative Care Model improves access to care and has shown promise in improving clinical outcomes for psychiatric and physical health conditions [ 43 , 44 ].…”

Section: General Methodsmentioning

confidence: 99%

A pilot study of participatory and rapid implementation approaches to increase depression screening in primary care

et al. 2021

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Background Most individuals with depression go unidentified and untreated. In 2016 the US Preventive Services Task Force released guidelines recommending universal screening in primary care to identify patients with depression and to link them to treatment. Feasible, acceptable, and effective strategies to implement these guidelines are needed. Methods This three-phased study employed rapid participatory methods to design and test strategies to increase depression screening at Penn Medicine, a large health system with 90 primary care practices. First, researchers solicited ideas and barriers from stakeholders to increase screening using an innovation tournament—a crowdsourcing method that invites stakeholders to submit ideas to address a workplace challenge. Second, a panel of stakeholders and scientists deliberated over and ranked the tournament ideas. An instant runoff election was held to select the winning idea. Third, the research team piloted the winning idea in a primary care practice using rapid prototyping, an approach that quickly refines and iterates strategy designs. Results The innovation tournament yielded 31 ideas and 32 barriers from diverse stakeholders (12 primary care physicians, 10 medical assistants, 4 nurse practitioners, 2 practice managers, and 4 patient support assistants). A panel of 6 stakeholders and scientists deliberated on the ideas and voted for patient self-report (i.e., through tablet computers, text message, or an online patient portal) as the winning idea. The research team rapid prototyped tablets in one primary care practice with one physician over 5 five-hour shifts to examine the feasibility, acceptability, and effectiveness of the strategy. Most patients, the physician, and medical assistants found the tablets acceptable and feasible. However, patient support assistants struggled to incorporate them in their workflow and expressed concerns about scaling up the process. Depression screening rates were higher using tablets compared to usual care; follow-up was comparable between tablets and usual care. Conclusions Rapid participatory methods engaged and amplified the voices of diverse stakeholders in primary care. These methods helped design an acceptable and feasible implementation strategy that showed promise for increasing depression screening in a primary care setting. The next step is to evaluate the strategy in a randomized controlled trial across primary care practices.

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Section: General Methodsmentioning

confidence: 99%

A pilot study of participatory and rapid implementation approaches to increase depression screening in primary care

et al. 2021

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“…Upper levels imply referral to clinicians for structured individual, group or couple psychotherapies; if appropriate, they can be accompanied by other psychosocial interventions or drug treatment in specialist settings. Assessments based on levels of severity are useful when delivered in a context making use of resources allocated to psychological therapies in primary care, as happened in England with the IAPT programme (Muntingh et al, 2016).…”

Section: Report Presented To the Jurymentioning

confidence: 99%

The Italian consensus conference on psychological therapies for anxiety and depressive disorders: findings and recommendations

Barbato

Bottesi

Biondi

et al. 2022

Epidemiol Psychiatr Sci

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A Consensus Conference of clinicians, researchers, public health specialists and users was convened in Italy to review efficacy, effectiveness, treatment appropriateness and access to care for anxiety and depression, and to consider the role of psychological therapies. Expert opinion was sought concerning identification of people requiring psychological therapies according to levels of symptom severity matched to corresponding levels of treatment intensity, suitability of psychological therapies for subclinical anxiety or depression, definition of a minimum level of information on evidence-based psychotherapies to be provided by university medical and psychology courses, initiatives to raise awareness among potential users and decision makers on the role and effectiveness of psychological therapies in healthcare. The expert jury concluded that a number of psychological therapy models endorsed by most authoritative guidelines are supported by research showing their effectiveness at least equal to the drugs used in common mental disorders (CMDs). Such therapies are under-represented in the Italian public health system, leading many people to resort to the private sector, resulting in unacceptable wealth discrimination. The difficulty of accessing psychological treatments often entails the use of drug therapies in cases where they are not indicated. Starting from these assumptions, the experts recommended the promotion of better and timely recognition of anxiety and depressive disorders and their classification in terms of symptom intensity and functional impairment, differentiating subthreshold mood swings from clinical forms, to foster outcome studies of psychotherapies in CMDs in Italy, to introduce a stepped care model structured according to levels of intensity of treatment, based on wellbeing support strategies in nonmedical contexts for subthreshold situations, self-help, support and psychoeducation as frontline interventions in mild clinical forms, evidence-based psychotherapies in moderate and severe forms, with the option of combining psychological treatment and appropriate drug therapy in the most severe cases.

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“…Further research has expanded beyond depressive disorders to include the effectiveness of collaborative care in management of bipolar disorder [16], PTSD [17], anxiety disorders [18], and chronic pain disorder [19]. Studies have also focused on specific populations such as the elderly [14,20], adolescents [21], women [22], and patients with cancer [23].…”

Section: Evidence For the Effectiveness Of Collaborative Carementioning

confidence: 99%

Integrated and Collaborative Care

et al. 2021

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Many patients with HIV receive care for neuropsychiatric disorders in HIV primary care clinics. This is at least partially due to a shortage of mental health specialists, which leads to long wait times and inadequate continuity of care. Stigma of mental illness can also be a major barrier to people seeking psychiatric care in mental health settings. In people with HIV, the stigma of mental illness is compounded by that of having HIV. Patients frequently fear discrimination and rejection and may avoid leaving HIV primary care settings to seek treatment in other settings. As a consequence, there is a need to provide psychiatric care in a setting that is accessible to, acceptable to, and supportive of the patient. Such a need also offers a tremendous opportunity to provide integrated biopsychosocial approaches to treat the whole patient with HIV.There are several integrated care models by which psychiatric care can be provided to patients with HIV. Integrated models of care for HIV psychiatry refer to a psychiatrist specializing in HIV psychiatry working closely with patients and other physicians to provide coordinated care for complex patients with HIV. Rarely is any model implemented in "complete" form. Rather, implementing integrated care involves local adaptations, based on availability of clinical resources, acceptability in existing clinic culture, and additions of clinical resources to address gaps in treatment. Integration occurs on a continuum, often starting with small changes and building on gains. Successful integration efforts capitalize on the strengths of team members and structure, occur in stages, and allow for revision based on feedback from clinicians and patients. Maintaining a dialogue among those who are developing and are impacted by integrated care programs is essential. Input from all stakeholders impacted by healthcare integration is important to make the organizational changes necessary to properly implement an integrated care system.Telepsychiatry is a useful technology to improve patients' access to psychiatric care and can be leveraged in any of the integrated care models [5]. It can enhance communication among clinical team members working at different sites. It can also be used to provide education and "curbside consultation" to HIV clinicians.In this chapter, we describe four models of integrated care that can be applied to HIV psychiatry: the consultation and referral model, the co-located model, the patient-centered medical home (PCMH), and the collaborative care model. Within our discussion of collaborative care, we describe key components, summarize the evidence base for collaborative care, list roles of key members of the collaborative care team, and identify essential areas of workforce training. We detail a systematic approach to screening, diagnosis, treatment, and monitoring. Some of the complexities of providing collaborative care for HIV, including stigma, isolation, and high rates of neuropsychiatric comorbidities, will be illustrated via patient cases.

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Collaborative Care for Anxiety Disorders in Primary Care: a Systematic Review and Meta-Analysis

Cited by 10 publications

References 44 publications

A pilot study of participatory and rapid implementation approaches to increase depression screening in primary care

A pilot study of participatory and rapid implementation approaches to increase depression screening in primary care

The Italian consensus conference on psychological therapies for anxiety and depressive disorders: findings and recommendations

Integrated and Collaborative Care

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