Huffman Jeff C, Niazi Shehzad K, Rundell James R, Sharpe Michael, Katon Wayne J
Department of Psychiatry, Harvard Medical School, Boston, MA; Department of Psychiatry, Massachusetts General Hospital, Boston, MA.
Department of Psychiatry, Mayo Clinic, Jacksonville, FL.
Psychosomatics. 2014 Mar-Apr;55(2):109-22. doi: 10.1016/j.psym.2013.09.002. Epub 2013 Dec 25.
Collaborative care interventions for psychiatric disorders combine several components integrated into the medical setting: (1) systematic psychiatric assessment, (2) use of a nonphysician care manager to perform longitudinal symptom monitoring, treatment interventions, and care coordination, and (3) specialist-provided stepped-care recommendations. Collaborative care interventions have now been evaluated in a wide spectrum of care settings and offer great promise as a way of increasing quality of patient care, improving health of populations, and reducing health care costs.
A systematic search of PubMed/MEDLINE databases was performed for publications between January 1970 and May 2013 to identify articles describing collaborative care and related interventions. Identified articles were then evaluated independently by multiple reviewers for quality and importance; additional articles were identified by searching reference lists and through recommendations of senior content-matter experts. The articles considered to be both of high quality and most important were then placed into categories and annotated reviews performed.
Over 600 articles were identified of which 67 were selected for annotated review. The results reported in these articles indicate that collaborative care interventions for psychiatric disorders have been consistently successful in improving key outcomes in both research and clinical intervention studies; cost analyses also suggest that this model is cost effective.
Collaborative care models for psychiatric disorders are likely to serve an increasingly large role in health care given their effect on patient and population outcomes and their focus on integration of care.
针对精神疾病的协作式护理干预措施整合了医疗环境中的多个组成部分:(1)系统的精神科评估;(2)利用非医生护理经理进行纵向症状监测、治疗干预和护理协调;(3)由专科医生提供逐步护理建议。目前,协作式护理干预已在广泛的护理环境中得到评估,并有望成为提高患者护理质量、改善人群健康状况以及降低医疗成本的一种方式。
对PubMed/MEDLINE数据库进行系统检索,查找1970年1月至2013年5月期间发表的描述协作式护理及相关干预措施的文章。然后由多位评审员独立评估所识别出的文章的质量和重要性;通过搜索参考文献列表以及资深主题专家的推荐来识别其他文章。接着将被认为质量高且最重要的文章进行分类并撰写注释性综述。
共识别出600多篇文章,其中67篇被选入注释性综述。这些文章中报告的结果表明,针对精神疾病的协作式护理干预在研究和临床干预研究中均持续成功地改善了关键结局;成本分析也表明该模式具有成本效益。
鉴于其对患者和人群结局的影响以及对护理整合的关注,精神疾病的协作式护理模式在医疗保健中可能会发挥越来越大的作用。