Sultan Meshal A, Pastrana Carlos S, Pajer Kathleen A
Mental Health Center of Excellence, Al Jalila Children's Specialty Hospital, Dubai, United Arab Emirates.
Neuroscience and Mental Health, Carleton University, Ottawa, Ontario, Canada.
Health Serv Res Manag Epidemiol. 2018 Mar 26;5:2333392818762886. doi: 10.1177/2333392818762886. eCollection 2018 Jan-Dec.
The aim of this review is to evaluate the effectiveness of shared/collaborative care between mental health-care providers and primary care providers (PCPs) on the outcomes of children and adolescents with attention-deficit/hyperactivity disorder (ADHD). This evaluation will be very helpful in the allocation of ADHD resources for models with the strongest evidence.
Using the Preferred Reporting Items for Systematic Review and Meta-analysis statement, we searched for randomized controlled trials, cohort, case-control, and cross-sectional studies on shared/collaborative care models in the treatment of ADHD. Using MEDLINE, PsycINFO, and CENTRAL databases from January 2000 to December 2016, we retrieved English language articles for review. The validation search identified 75 records. Five studies met the inclusion criteria and were analyzed in this systematic review. There were insufficient data for a meta-analysis. The included studies involved 655 children and adolescents who had a diagnosis of ADHD. The Cochrane Collaboration's tool for assessing risk of bias was used to estimate bias.
Overall, the results show that the effects of shared/collaborative care models were small to moderate (effect size: 0.1-0.6, = .04) on symptom rating scales, but all positively affected functional outcomes (effect size: 0.3-0.7, = .04-.01). The data indicated that the models were associated with increased PCPs' comfort levels, but the evidence for increased capacity for diagnosing and managing ADHD was weaker.
This review concludes that the current studies do not show strong evidence for the outcome of collaboration between PCPs and mental health professionals on ADHD management. Future research should consider providing education to PCPs on management guidelines prior to conducting the trials, and more innovation is needed to discover methods of collaboration that affect the direct care of ADHD.
本综述旨在评估精神卫生保健提供者与初级保健提供者（PCP）之间的共享/协作护理对注意力缺陷多动障碍（ADHD）儿童和青少年治疗效果的影响。该评估对于为证据最充分的模式分配ADHD资源将非常有帮助。
我们使用系统评价和Meta分析的首选报告项目声明，搜索了关于共享/协作护理模式治疗ADHD的随机对照试验、队列研究、病例对照研究和横断面研究。我们使用2000年1月至2016年12月的MEDLINE、PsycINFO和CENTRAL数据库，检索英文文章进行综述。验证性检索识别出75条记录。五项研究符合纳入标准，并在本系统评价中进行了分析。数据不足以进行Meta分析。纳入的研究涉及655名被诊断为ADHD的儿童和青少年。使用Cochrane协作网的偏倚风险评估工具来估计偏倚。
总体而言，结果表明，共享/协作护理模式对症状评定量表的影响为小到中等（效应量：0.1 - 0.6，P = 0.04），但对功能结局均有积极影响（效应量：0.3 - 0.7，P = 0.04 - 0.01）。数据表明，这些模式与PCP舒适度的提高相关，但在诊断和管理ADHD能力提高方面的证据较弱。
本综述得出结论，目前的研究没有显示出PCP与精神卫生专业人员在ADHD管理方面合作效果的有力证据。未来的研究应考虑在进行试验之前为PCP提供管理指南方面的教育，并且需要更多创新来发现影响ADHD直接护理的协作方法。
