Individualized stepped care of chronic illness

M, Von Korff; Tiemens, Bea

doi:10.1136/ewjm.172.2.133

Cited by 152 publications

(108 citation statements)

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“…The often applied stepped care approach in which patients indiscriminately receive brief and low‐intensity intervention at start of treatment and intensifying efforts in case of insufficient signs of recovery, may, however, prevent the accurate and timely selection of the best initial treatment. Although the stepped care approach is considered a resource efficient approach for patients who recover with minimal intervention (Meeuwissen, van der Feltz‐Cornelis, Christina M, van Marwijk, Rijnders, & Donker, 2008; Von Korff & Tiemens, 2000), the effectiveness of this approach is questionable in patients who need subsequent referral to highly specialized mental healthcare services. Secondary or even tertiary referral to highly specialized mental healthcare services delays the initiation of appropriate treatment, which, in turn, is associated with poor treatment outcomes in terms of relapse, recurrence, and chronicity (Hirschfeld et al., 1997; Keller, 1994; Meyers et al., 2002).…”

Section: Introductionmentioning

confidence: 99%

Indicators to facilitate the early identification of patients with major depressive disorder in need of highly specialized care: A concept mapping study

et al. 2018

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BackgroundEarly identification of the subgroup of patients with major depressive disorder (MDD) in need of highly specialized care could enhance personalized intervention. This, in turn, may reduce the number of treatment steps needed to achieve and sustain an adequate treatment response. The aim of this study was to identify patient‐related indicators that could facilitate the early identification of the subgroup of patients with MDD in need of highly specialized care.MethodsInitial patient indicators were derived from a systematic review. Subsequently, a structured conceptualization methodology known as concept mapping was employed to complement the initial list of indicators by clinical expertise and develop a consensus‐based conceptual framework. Subject‐matter experts were invited to participate in the subsequent steps (brainstorming, sorting, and rating) of the concept mapping process. A final concept map solution was generated using nonmetric multidimensional scaling and agglomerative hierarchical cluster analyses.ResultsIn total, 67 subject‐matter experts participated in the concept mapping process. The final concept map revealed the following 10 major clusters of indicators: 1‐depression severity, 2‐onset and (treatment) course, 3‐comorbid personality disorder, 4‐comorbid substance use disorder, 5‐other psychiatric comorbidity, 6‐somatic comorbidity, 7‐maladaptive coping, 8‐childhood trauma, 9‐social factors, and 10‐psychosocial dysfunction.ConclusionsThe study findings highlight the need for a comprehensive assessment of patient indicators in determining the need for highly specialized care, and suggest that the treatment allocation of patients with MDD to highly specialized mental healthcare settings should be guided by the assessment of clinical and nonclinical patient factors.

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Section: Introductionmentioning

confidence: 99%

Indicators to facilitate the early identification of patients with major depressive disorder in need of highly specialized care: A concept mapping study

et al. 2018

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“…Multidisciplinary care is a care approach that addressed complex care needs by utilising a broader set of skills in assessment and ongoing care held by providers from different disciplines, specialties and /or professions who could contribute independently. Another relevant concept is stepped care, which proposes care of increasing intensity depending on the complexity or advanced nature of the condition (Von Korff and Tiemens 2000;Smink et al 2014). For the purposes of this project, we have elected to use the term 'integrated care', as we are interested in the concept of systematic, organised interaction between primary and secondary care.…”

Section: Introductionmentioning

confidence: 99%

Systematic review of integrated models of health care delivered at the primary–secondary interface: how effective is it and what determines effectiveness?

Mitchell

Burridge

Zhang

et al. 2015

Aust. J. Prim. Health

116

144

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Abstract.Integrated multidisciplinary care is difficult to achieve between specialist clinical services and primary care practitioners, but should improve outcomes for patients with chronic and/or complex chronic physical diseases. This systematic review identifies outcomes of different models that integrate specialist and primary care practitioners, and characteristics of models that delivered favourable clinical outcomes. For quality appraisal, the Cochrane Risk of Bias tool was used. Data are presented as a narrative synthesis due to marked heterogeneity in study outcomes. Ten studies were included. Publication bias cannot be ruled out. Despite few improvements in clinical outcomes, significant improvements were reported in process outcomes regarding disease control and service delivery. No study reported negative effects compared with usual care. Economic outcomes showed modest increases in costs of integrated primary-secondary care. Six elements were identified that were common to these models of integrated primary-secondary care: (1) interdisciplinary teamwork; (2) communication/information exchange; (3) shared care guidelines or pathways; (4) training and education; (5) access and acceptability for patients; and (6) a viable funding model. Compared with usual care, integrated primary-secondary care can improve elements of disease control and service delivery at a modestly increased cost, although the impact on clinical outcomes is limited. Future trials of integrated care should incorporate design elements likely to maximise effectiveness.

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“…specific treatment modules adapted to condition- and patient-specific psychological stress and resilience factors) reflect aspects of personalized healthcare in the field of psychotherapy. All those factors are increasingly recognized as important in the treatment of (somatic) conditions [17,18,25,26,27] and become more common in clinical practice and research [28,29,30]. In fact, by taking into account the large individual variability in disease outcome, psychological comorbidity, and psychological risk and resilience factors, more specialized treatment may be offered to those most likely to benefit (e.g.…”

Section: Therapeutic Strategies For Personalized Healthcarementioning

confidence: 99%

Incorporating Biopsychosocial Characteristics into Personalized Healthcare: A Clinical Approach

Evers

Gieler

Hasenbring

et al. 2014

Psychother Psychosom

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Individualized stepped care of chronic illness

Cited by 152 publications

References 32 publications

Indicators to facilitate the early identification of patients with major depressive disorder in need of highly specialized care: A concept mapping study

Indicators to facilitate the early identification of patients with major depressive disorder in need of highly specialized care: A concept mapping study

Systematic review of integrated models of health care delivered at the primary–secondary interface: how effective is it and what determines effectiveness?

Incorporating Biopsychosocial Characteristics into Personalized Healthcare: A Clinical Approach

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