Specific content for collaborative care: a systematic review of collaborative care interventions for patients with multimorbidity involving depression and/or anxiety in primary care

Abstract

Background In primary care (PC) many patients suffer from multimorbidity involving depression and/or anxiety. Collaborative care (CC) has shown promising results for patients with depression, anxiety, and multimorbidity involving depression. However, specific content in CC for patients with multimorbidity involving depression and/or anxiety is unknown. Objective (i) To examine the effect of CC interventions in patients with multimorbidity involving depression and/or anxiety compared with usual care; (ii) to identify specific content of CC. Methods We conducted a systematic literature review of randomized controlled trial studies evaluating CC models for adults with multimorbidity involving depression and/or anxiety in PC settings. PubMed, CINAHL, Web of Science, and PsycInfo were searched in December 2019. We conducted a qualitative synthesis using an existing framework and developed a new framework to map the content for each studied intervention. Results We identified 1,447 studies. Twelve publications were included. Eleven had medium-to-high quality of CC for patients with multimorbidity involving depression. Specific content of CC in these studies is: A stepped care model, involving medication and psychotherapy delivered by a nurse or psychologist Care Manager (CM) focusing on problem-solving techniques; follow-up including monitoring of symptoms and function, and relapse prevention strategies; scheduled CM supervision. Conclusions Specific content for CC for patients with multimorbidity involving depression is identified from current research. Research gaps were found regarding CC for patients with multimorbidity and anxiety, depression and anxiety, and depression and/or anxiety and more than 2 diseases.

Psychotherapeutic nursing as Advanced Clinical Practice for the promotion of mental health in Spain

“…Horatio: European Psychiatric Nurses and the American Psychiatric Nurses Association advocate for including PTN as the fourth ‘P’ of ACPs, joining psychopharmacology, physical assessment and pathophysiology. Nurses have been shown to effectively provide psychotherapy in a variety of settings, including mental health, chronic illness and bereavement (Kappelin et al., 2022; Lau et al, 2021; Li et al., 2022; Maleki et al., 2022; Robinson & Robinson, 2022; Sass et al., 2022; Sharifipour et al., 2022; Vlachou et al., 2022).…”

“…Literature reviews published in the past two decades have validated the technical and interpersonal skills of mental health nurses, affirming their effectiveness in treating individuals with moderate to severe mental health issues (Hurley et al., 2022). The scope of mental health nurses’ psychotherapeutic roles encompasses a variety of areas such as palliative care, geriatric care, diabetes, alcohol abuse, self‐harm, suicidality, perinatal care, infertility, neonatal care, lung cancer, treatment of schizophrenia and management of multimorbidity, including depression and anxiety in primary care settings (Abujelban et al., 2023; de Pinho et al., 2020; Hayashi & Onishi, 2021; Kappelin et al., 2022; Li et al., 2022; Malakian et al, 2022; Maleki et al., 2022; Omkarappa et al., 2021; Popp et al., 2022; Sampson, 2023; Sass et al., 2022; Sharifipour et al., 2022; Sriati et al., 2023; van Klinken et al., 2023; Vlachou et al., 2022; Yanık & Kavak Budak, 2023).…”

Dancing with the patient: a qualitative study of general practitioners’ experiences of managing patients with multimorbidity and common mental health problems

“…Regarding the use of CC in complex intervention development for these patients, the care model involves teamwork between a GP and a district nurse, and a structure for relational continuity which the GPs ask for. However, the structured management plan fails to correspond to patients with multimorbidity and CMHPs' needs of individualised care and flexibility to address aspects of physical, mental, and social needs [21][22][23]. Moreover, CC often lacks structures for teamwork outside of the primary care practice, such as with the municipalities.…”

“…Collaborative care (CC) is a complex intervention that has shown positive results for patients with multimorbidity involving depression, yet further research is needed [21][22][23]. CC is a care model for teamwork between the patient, the GP and a nurse care manager.…”

“…CC has shown positive results in primary care settings in reducing depressive symptoms in patients with depression both internationally [25] and in Sweden [26], in reducing anxiety symptoms in patients with anxiety [25], as well as in reducing depressive symptoms in patients with multimorbidity involving depression and one more chronic disease [22]. However, there are no studies showing CC to be effective for patients with multimorbidity involving anxiety [23], for patient with complex multimorbidity [22,23], or set in a Swedish context [22]. Optimal development, testing, evaluation and implementation of complex interventions like CC in a new context requires attention and adaptation [27].…”