Collaborative Care: Models for Treatment of Patients with Complex Medical-Psychiatric Conditions

Abstract

Patients with co-morbidity and multi-morbidity have worse outcomes and greater healthcare needs. Co-morbid depression and other long-term conditions present health services with challenges in delivering effective care for patients. We provide some recent evidence from the literature to support the need for collaborative care, illustrated by practical examples of how to deliver a collaborative/integrated care continuum by presenting data collected between 2011 and 2012 from a London Borough clinical improvement programme that compared co-morbid diagnosis of depression and other long-term conditions and Accident and Emergency use. We have provided some practical steps for developing collaborative care within primary care and suggest that primary care family practices should adopt closer collaboration with other services in order to improve clinical outcomes and cost-effectiveness.

Integrated Care and the Evolution of the Multidisciplinary Team

“…Conversely, however, "reverse integration" refers to the practice of using a medical professional within a mental health setting and typically consists of more traditional colocated services. [15][16][17] Although a variety of professionals may provide this service, there are essential skill sets shared between all (Box 11). Customization is especially important, as emphasizing a colocated traditional model of the 1-hour therapy appointment will preclude the true integration of an expanded variety of clinical services, limit efforts at patient engagement, limit the number of patients assisted, and functionally isolate the therapist, stifling their ability to truly function as a member of the clinical treatment team.…”

“…22 The implications for the education of mental health providers are equally as important, and new programming is beginning to address the concepts and skills necessary for this expanded type of practice. 6,8,17,20,21 Indeed, integrated clinics provide a unique opportunity for blended interdisciplinary educational efforts. Lessons learned from integrated care are especially expected to transform the practice of psychiatry.…”

Anxious and depressed women's experiences of emotional suffering and help seeking in a Rio de Janeiro favela

“…Disregarding these circumstances might affect patients´ quality of life 4 and worsen the prognosis of chronic physical diseases 5 . Common mental disorders (CMD) are also strongly associated with gender issues and social inequity 6,7 .…”

Informing mental health policies and services in the EMR: cost-effective deployment of human resources to deliver integrated community-based care

“…(4) There is increasing evidence that noncommunicable diseases and mental health co-morbidity have an additive effect (5)(6)(7)(8) and this suggests that mental health-care skills need to be embedded throughout the primary care workforce. In a review of 23 low-and medium-income countries it has been estimated that if nothing is done to address chronic diseases in developing countries, US$ 84 billion of economic production could be lost, in addition to the high costs of care to the health systems (9).…”

“…The impact and financial cost of longterm health problems in 23 low-and medium-income countries similar to those in the EMR has been estimated at US$ 84 billion if nothing is done to address problems such as heart disease, stroke and diabetes (6)(7)(8)(9). When mental health co-morbidity is added into the equation, this loss may be as much as 70% greater.…”