Reeves Penny, Szewczyk Zoe, Proudfoot Judith, Gale Nyree, Nicholas Jennifer, Anderson Josephine
Hunter Medical Research Institute, AU.
School of Medicine and Public Health, University of Newcastle, AU.
Int J Integr Care. 2019 Jun 21;19(2):8. doi: 10.5334/ijic.4157.
Since the mid-2000s stepped care, a model of integrated healthcare delivery, has been promoted for offering accessible, effective and efficient services for individuals with mental health conditions. However, adoption of the model has not been widespread warranting additional investment by way of implementation strategies to encourage uptake. These strategies also require funding and their value for money should be assessed to inform decision making and practice. We conducted a review to better understand the extent to which the cost-effectiveness of stepped care has been evaluated (review i) and also to investigate whether economic evaluation has been applied to implementation strategies of stepped care services for anxiety and depression in developed (high income) countries and to chart their methods and outcomes (review ii). The searches were conducted in six electronic databases, grey literature and relevant journals. The search strategies returned two papers for reviews (i) and a single paper for review (ii). Despite stepped care models of integrated mental health service provision being promoted as optimal, there is limited knowledge surrounding the real-world cost-effectiveness of their application and clearly a need for good quality economic evaluations of integrated care that comply with international guidelines of good practice. There is even less information pertaining to the cost-effectiveness and budget impact of strategies designed to increase the uptake of these models.
自21世纪中叶以来，逐步照护这一综合医疗服务提供模式得到推广，旨在为有心理健康问题的个人提供可及、有效且高效的服务。然而，该模式的采用并不广泛，需要通过实施策略进行额外投资以鼓励采用。这些策略也需要资金，并且应该评估其性价比，以为决策和实践提供依据。我们进行了一项综述，以更好地了解逐步照护的成本效益得到评估的程度（综述一），并调查经济评估是否已应用于发达国家（高收入国家）焦虑和抑郁逐步照护服务的实施策略，并梳理其方法和结果（综述二）。检索在六个电子数据库、灰色文献和相关期刊中进行。检索策略为综述（一）返回了两篇论文，为综述（二）返回了一篇论文。尽管综合心理健康服务提供的逐步照护模式被推广为最佳模式，但对于其实际应用的成本效益的了解有限，显然需要对符合国际良好实践指南的综合照护进行高质量的经济评估。关于旨在提高这些模式采用率的策略的成本效益和预算影响的信息甚至更少。
