Descriptive Analysis of a Novel Health Care Approach

Shackelford, Jennifer; Sirna, Megan; Mangurian, Christina; Dilley, James; Shumway, Martha

doi:10.4088/pcc.13m01530

Cited by 13 publications

(9 citation statements)

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“…Advisory group service users told us that they would like to know that there is someone with responsibility for the physical health needs of SMI service users, particularly in the inpatient setting. We also found several published descriptions of primary care clinics or placement of physical health practitioners in inpatient [5261] and outpatient [11143637385357] mental health settings. Field experts also described existing services such as dedicated GP sessions on forensic wards and in-reach specialist diabetes nurses.…”

Section: Resultsmentioning

confidence: 59%

“…This emphasises that people rather than organisational systems or structures are primarily responsible for the successful integration of care. Much of the published evidence on co-located care identified through this mapping review was concerned with the primary care professionals providing clinics in community or inpatient mental health settings [1011143051535761]. The literature also highlighted the need for willing, interested, committed and passionate staff [57] plus commitment from leaders and administrators [30].…”

Section: Resultsmentioning

confidence: 99%

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Integrated Care to Address the Physical Health Needs of People with Severe Mental Illness: A Mapping Review of the Recent Evidence on Barriers, Facilitators and Evaluations

Rodgers

Dalton

Harden

et al. 2018

International Journal of Integrated Care

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People with mental health conditions have a lower life expectancy and poorer physical health outcomes than the general population. Evidence suggests this is due to a combination of clinical risk factors, socioeconomic factors, and health system factors, notably a lack of integration when care is required across service settings.Several recent reports have looked at ways to better integrate physical and mental health care for people with severe mental illness (SMI). We built on these by conducting a mapping review that looked for the most recent evidence and service models in this area. This involved searching the published literature and speaking to people involved in providing or using current services.Few of the identified service models were described adequately and fewer still were evaluated, raising questions about the replicability and generalisability of much of the existing evidence. However, some common themes did emerge. Efforts to improve the physical health care of people with SMI should empower staff and service users and help remove everyday barriers to delivering and accessing integrated care. In particular, there is a need for improved communication among professionals and better information technology to support them, greater clarity about who is responsible and accountable for physical health care, and greater awareness of the effects of stigmatisation on the wider culture and environment in which services are delivered.

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Section: Resultsmentioning

confidence: 59%

Section: Resultsmentioning

confidence: 99%

Integrated Care to Address the Physical Health Needs of People with Severe Mental Illness: A Mapping Review of the Recent Evidence on Barriers, Facilitators and Evaluations

Rodgers

Dalton

Harden

et al. 2018

International Journal of Integrated Care

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“…32,37,41,52,58,63,67,69 However, these might also be considered 'liaison' services that happen to be colocated; other publications have described similar clinics within virtual 'Health Home' organisations where colocation is not strictly necessary. 62 Therefore, issues relating primarily to liaison are discussed in Liaison services (17 studies).…”

Section: Colocation Of Services (19 Studies)mentioning

confidence: 99%

“…Although referral criteria were not formalised, the aim was to capture people with a chronic medical illness who are unable to navigate a traditional primary care setting. 63 …”

Section: Liaison Services (17 Studies)mentioning

confidence: 99%

Integrated care to address the physical health needs of people with severe mental illness: a rapid review

Rodgers

Dalton

Harden

et al. 2016

Health Serv Deliv Res

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BackgroundPeople with mental health conditions have a lower life expectancy and poorer physical health outcomes than the general population. Evidence suggests that this discrepancy is driven by a combination of clinical risk factors, socioeconomic factors and health system factors.Objective(s)To explore current service provision and map the recent evidence on models of integrated care addressing the physical health needs of people with severe mental illness (SMI) primarily within the mental health service setting. The research was designed as a rapid review of published evidence from 2013–15, including an update of a comprehensive 2013 review, together with further grey literature and insights from an expert advisory group.SynthesisWe conducted a narrative synthesis, using a guiding framework based on nine previously identified factors considered to be facilitators of good integrated care for people with mental health problems, supplemented by additional issues emerging from the evidence. Descriptive data were used to identify existing models, perceived facilitators and barriers to their implementation, and any areas for further research.Findings and discussionThe synthesis incorporated 45 publications describing 36 separate approaches to integrated care, along with further information from the advisory group. Most service models were multicomponent programmes incorporating two or more of the nine factors: (1) information sharing systems; (2) shared protocols; (3) joint funding/commissioning; (4) colocated services; (5) multidisciplinary teams; (6) liaison services; (7) navigators; (8) research; and (9) reduction of stigma. Few of the identified examples were described in detail and fewer still were evaluated, raising questions about the replicability and generalisability of much of the existing evidence. However, some common themes did emerge from the evidence. Efforts to improve the physical health care of people with SMI should empower people (staff and service users) and help remove everyday barriers to delivering and accessing integrated care. In particular, there is a need for improved communication between professionals and better information technology to support them, greater clarity about who is responsible and accountable for physical health care, and awareness of the effects of stigmatisation on the wider culture and environment in which services are delivered.Limitations and future workThe literature identified in the rapid review was limited in volume and often lacked the depth of description necessary to acquire new insights. All members of our advisory group were based in England, so this report has limited information on the NHS contexts specific to Scotland, Wales and Northern Ireland. A conventional systematic review of this topic would not appear to be appropriate in the immediate future, although a more interpretivist approach to exploring this literature might be feasible. Wherever possible, future evaluations should involve service users and be clear about which outcomes, facilitators and barriers are likely to be context-specific and which might be generalisable.FundingThe research reported here was commissioned and funded by the Health Services and Delivery Research programme as part of a series of evidence syntheses under project number 13/05/11. For more information visitwww.nets.nihr.ac.uk/projects/hsdr/130511.

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“…Empirical evidence following implementation of the ACA may, it is hoped, lead to improvements in health care for those with serious mental illnesses through the use of, among other things, health homes [17,56], co-location of services [57], and payment reform [58]. A gap remains, however, between interventions effective in research settings and translation and uptake in communitybased organizations [59].…”

Section: Original Researchmentioning

confidence: 99%

Costs of implementing a behavioral weight-loss and lifestyle-change program for individuals with serious mental illnesses in community settings

Stumbo

Yarborough

et al. 2015

Behav. Med. Pract. Policy Res.

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Little research has examined costs of adopting a successful lifestyle intervention for people with serious mental illnesses in community clinics. The study aims to calculate the real-world costs of implementing a group-based weight-loss and lifestyle intervention in community settings. We used empirically derived costs to estimate implementation costs and conducted sensitivity analyses to estimate costs: (1) when implementing the intervention in high/low resource-intensive environments and (2) assuming variability in participant enrollment. To implement the STRIDE program for 15 individuals with serious mental illnesses, we estimated costs for the 12-month (30-session) intervention, with materials available in the public domain, at $16,427 or $1095 per participant. The majority of costs, $12,767, were associated with direct labor costs. Replication costs are largely associated with labor. Community health centers offer an untapped resource for implementing behavioral-lifestyle interventions, particularly under the Affordable Care Act, though additional payment reforms or incentives may be needed.

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Descriptive Analysis of a Novel Health Care Approach

Cited by 13 publications

References 0 publications

Integrated Care to Address the Physical Health Needs of People with Severe Mental Illness: A Mapping Review of the Recent Evidence on Barriers, Facilitators and Evaluations

Integrated Care to Address the Physical Health Needs of People with Severe Mental Illness: A Mapping Review of the Recent Evidence on Barriers, Facilitators and Evaluations

Integrated care to address the physical health needs of people with severe mental illness: a rapid review

Costs of implementing a behavioral weight-loss and lifestyle-change program for individuals with serious mental illnesses in community settings

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