School of Nursing and Midwifery, Flinders University, Adelaide, Australia.
BMC Health Serv Res. 2011 Apr 11;11:72. doi: 10.1186/1472-6963-11-72.
With the move to community care and increased involvement of generalist health care providers in mental health, the need for health service partnerships has been emphasised in mental health policy. Within existing health system structures the active strategies that facilitate effective partnership linkages are not clear. The objective of this study was to examine the evidence from peer reviewed literature regarding the effectiveness of service linkages in primary mental health care.
A narrative and thematic review of English language papers published between 1998 and 2009. Studies of analytic, descriptive and qualitative designs from Australia, New Zealand, UK, Europe, USA and Canada were included. Data were extracted to examine what service linkages have been used in studies of collaboration in primary mental health care. Findings from the randomised trials were tabulated to show the proportion that demonstrated clinical, service delivery and economic benefits.
A review of 119 studies found ten linkage types. Most studies used a combination of linkage types and so the 42 RCTs were grouped into four broad linkage categories for meaningful descriptive analysis of outcomes. Studies that used multiple linkage strategies from the suite of "direct collaborative activities" plus "agreed guidelines" plus "communication systems" showed positive clinical (81%), service (78%) and economic (75%) outcomes. Most evidence of effectiveness came from studies of depression. Long term benefits were attributed to medication concordance and the use of case managers with a professional background who received expert supervision. There were fewer randomised trials related to collaborative care of people with psychosis and there were almost none related to collaboration with the wider human service sectors. Because of the variability of study types we did not exclude on quality or attempt to weight findings according to power or effect size.
There is strong evidence to support collaborative primary mental health care for people with depression when linkages involve "direct collaborative activity", plus "agreed guidelines" and "communication systems".
随着社区护理的发展以及全科医疗服务提供者更多地参与精神卫生保健，精神卫生政策强调了卫生服务合作的必要性。在现有卫生系统结构中，促进有效伙伴关系联系的积极策略尚不清楚。本研究的目的是审查同行评议文献中关于初级精神卫生保健中服务联系有效性的证据。
对 1998 年至 2009 年期间发表的英文论文进行叙述性和主题性综述。纳入来自澳大利亚、新西兰、英国、欧洲、美国和加拿大的分析性、描述性和定性设计的研究。提取数据以检查在初级精神卫生保健合作研究中使用了哪些服务联系。对随机试验的结果进行制表，以显示显示临床、服务提供和经济效益的比例。
对 119 项研究的综述发现了十种联系类型。大多数研究使用了多种联系类型，因此，42 项随机对照试验被分为四大类，以便对结果进行有意义的描述性分析。使用“直接合作活动”加上“约定准则”加上“沟通系统”这一整套联系策略的研究显示出积极的临床（81%）、服务（78%）和经济效益（75%）。大多数有效性证据来自抑郁症的研究。长期效益归因于药物一致性和使用具有专业背景并接受专家监督的病例经理。与精神分裂症患者的协作护理相关的随机试验较少，与更广泛的人类服务部门的协作几乎没有。由于研究类型的可变性，我们没有根据质量排除研究，也没有试图根据权力或效果大小对结果进行加权。
当联系涉及“直接合作活动”、“约定准则”和“沟通系统”时，有强有力的证据支持针对抑郁症患者的协作初级精神卫生保健。
