Transitioning patients from outpatient mental health services to primary care: A rapid literature review

Abstract

Background A lack of access to mental health services is a critical barrier to obtaining evidence-based care. One strategy to improve access is to transition stable patients out of mental health specialty services and into primary care, thus opening availability for new patients and those with acute mental health needs. To support these transitions, organizations might explore a range of new practices and implementation strategies. Methods We conducted a rapid literature review to summarize descriptions from the research literature about practices for transitioning stable patients from outpatient mental health services to primary care, as well as implementation strategies to enhance the adoption and sustainment of these practices. We searched PsycINFO and Cumulated Index to Nursing and Allied Health Literature (CINAHL) for articles published between January 2000 and August 2019. For articles meeting inclusion criteria, we abstracted data on study characteristics, transition practices, and implementation strategies. Results We included 11 articles representing diverse study designs, settings, and health care organizations. Across these articles, we identified six categories of commonly described transition practices, with patient engagement appearing the most frequently (10 articles), followed by shared treatment planning (eight articles), assessment of recovery and stability, care coordination, follow up and support, and medication management (seven articles each). Less frequently, articles included descriptions of implementation strategies, with five articles describing efforts to train and educate stakeholders and four articles describing the use of evaluative and iterative strategies. Conclusions We identified descriptions of several common practices to help patients transition from mental health specialty services to primary care, but there are opportunities for an increased focus on implementation strategies to enhance the adoption and sustainment of these transition practices. More research is needed to better understand the effectiveness of specific transition interventions and the feasibility of deploying these interventions in heterogeneous health care settings.

Strategies to recruit rural primary care providers to implement a medication for opioid use disorder (MOUD) focused integrated care model

“…Future research focused on characterizing the mechanisms underlying positive organizational changes (e.g., organizational health, provider self-efficacy) ( Lewis et al, 2021 ; Shapiro et al, 2021 ; Vax et al, 2021 ) as well as the extent to which organizational or implementation metrics have a demonstrated impact on the patient experience (e.g., individualized care; reduced wait times; appropriate care transitions; wraparound services) is needed. Consistent with recent calls for more patient-centered care ( Marchand et al, 2019 ), future research using these systems to characterize the impact of implementation metrics on patient-reported recovery outcomes (cf., administrative claims data) is needed ( Blasi et al, 2021 ).…”

Interventions Promoting Recovery from Depression for Patients Transitioning from Outpatient Mental Health Services to Primary Care: Protocol for a Scoping Review

“…Currently, the best available evidence in the field is a rapid review from 2021 by Blasi et al [63] that identified practices for transitioning stable patients from outpatient mental health services to primary care, and a systematic review from 2006 by Gunn et al [64] that assessed the effects of chronic illness management approaches for patients with depression in primary care. The rapid review by Blasi et al [63] included 11 articles representing six categories of transition practices, with patient engagement as the most commonly described transition practice, followed by shared treatment planning, assessment of recovery and stability, care coordination, follow-up and support, and medication management. However, the review did not draw conclusions about best practices or the importance of specific transition processes or strategies, including interventions that promotes recovery for patients transitioning.…”

“…However, the review did not draw conclusions about best practices or the importance of specific transition processes or strategies, including interventions that promotes recovery for patients transitioning. In addition, the authors may have missed some relevant articles due to the rapid review timeline for literature searching and study selection [63]. The systematic review by Gunn et al [64] found that system level interventions in primary care can led to a modest increase in recovery from depression.…”

“…However, these reviews were not specific to our target group of interest, did not focus on clinical recovery or patients transitioning from outpatient mental health services to primary care [61, 62]. Currently, the best available evidence in the field is a rapid review from 2021 by Blasi et al [63] that identified practices for transitioning stable patients from outpatient mental health services to primary care, and a systematic review from 2006 by Gunn et al [64] that assessed the effects of chronic illness management approaches for patients with depression in primary care. The rapid review by Blasi et al [63] included 11 articles representing six categories of transition practices, with patient engagement as the most commonly described transition practice, followed by shared treatment planning, assessment of recovery and stability, care coordination, follow-up and support, and medication management.…”

Discharge from Secondary Care Services to Primary Care for Adults with Serious Mental Illness: A Scoping Review

“…(7,12) A review conducted by the National Institute for Health and Care Excellence found no high-quality evidence with outcomes related to successful transitions to a lower level of support. (13) Blasi and colleagues (14) conducted a rapid review of the existent literature on discharge from SCSs to PCPs; however, limitations to this review are the limited number of databases searched and broad outpatient populations. Kim and colleagues (15) intended to conduct a scoping review of barriers and facilitators for transitions from specialty mental health services to primary care from the years 2000-2016.…”