Ways of working at the interface between primary and specialist mental healthcare

Gask, Linda; Khanna, Tarun

doi:10.1192/bjp.bp.109.075382

Cited by 29 publications

(27 citation statements)

References 9 publications

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“…An alternative to the stepped care approach is matched care. In this approach, patient management and initial treatment allocation is tailored to the individual patient needs (Gask & Khanna, 2011; Ridgway & Williams, 2011; Van Straten, Tiemens, Hakkaart, Nolen, & Donker, 2006). Successful application of this approach may reduce the number of treatment steps needed to achieve and sustain an adequate treatment response, benefit the quality of life of patients, and increase the cost‐effective use of resources.…”

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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“…Taken together these findings suggest scope for improving collaboration between the primary and secondary care to better support the recovery of those with a history of SMI after discharge. Mental health outreach in primary care by psychiatric nurses, co-locating mental health and primary care services and other integrative/shared care models have begun to be explored (Gask & Khanna, 2011). In Lambeth, the ''Living Well Collaborative'' comprised of patients, mental health and primary care professionals, and other key stakeholders has been instigated to provide a synergistic approach to the commissioning and delivery of local services (England et al, 2013).…”

Section: Discussionmentioning

confidence: 98%

Acute mental health service use by patients with severe mental illness after discharge to primary care in South London

Ramanuj¹,

Carvalho²,

Harland³

et al. 2015

Journal of Mental Health

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“…Involvement of consultants in local educational activities in addition to link-worker (mental health practitioner) visits to local surgeries would be desirable as these have been shown to be effective in improving the appropriateness of outpatient referral (Akbari et al 2008). This provides the opportunity for the psychiatrist to play a key role in developing the interface with primary care (Gask & Khanna, 2011). Postgraduate training of GPs in mental health has also been identified as a factor required for improving mental health care in primary care and referrals to psychiatric services (Copty & Whitford, 2005).…”

Section: Discussionmentioning

confidence: 99%

Improving general practitioners’ referral details of antidepressant use for patients referred for depression to primary mental health care: re-audit

Towobola¹,

Cunningham²,

Cotter³

2015

Ir. j. psychol. Med.

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Background. This audit cycle looked at details of antidepressants given in general practitioners' (GPs) referral letters to Primary Mental Health Care (PMHC). With adequate information when patients are referred, time spent in clarifying details could be put into better use by clinicians and prompt effective treatment would help to reduce the direct and indirect costs of depression.Objective. To evaluate how effective our intervention was 7 months after a previous audit and identify areas that need improvement.Method. Audit of 33 referral letters of patients referred for depression from GPs to a PMHC service in Northern Ireland, followed by the intervention (feedback and pro forma) and re-audit after 7 months.Results. The April audit showed 100% documentation of current antidepressant treatment and dose, but showed poor documentation of previous antidepressant use (33%), dose or duration (15%) and the reason for stopping the treatment (3%). Following intervention, the re-audit showed 25% and 24% rise in documenting previous antidepressant used and maximum dose reached, respectively, and 20% rise in documenting the reason for stopping.Conclusions. Our interventions made modest improvement in providing relevant data in referral letters. This study adds to the existing evidence that relying mainly on feedback as a method of implementing change is ineffective. Lack of enthusiasm for using the newly introduced pro forma suggests that mental health services should obtain more effective ways of engaging GPs in service development. Using a systematic approach, which includes identifying local barriers to change and providing a supportive environment are important before the next re-audit.

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Ways of working at the interface between primary and specialist mental healthcare

Abstract: Ways of working at the interface between primary and specialist care are considered with discussion of the limits of available evidence and the potential for a new role for psychiatrists in providing supervision and consultation in novel models of care.

Cited by 29 publications

References 9 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

Acute mental health service use by patients with severe mental illness after discharge to primary care in South London

Improving general practitioners’ referral details of antidepressant use for patients referred for depression to primary mental health care: re-audit

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