Woods Jean-Baptiste, Greenfield Geva, Majeed Azeem, Hayhoe Benedict
Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK.
Department of Primary Care & Public Health, Imperial College London, London, UK
BMJ Open. 2020 Dec 2;10(12):e042052. doi: 10.1136/bmjopen-2020-042052.
Mental health disorders contribute significantly to the global burden of disease and lead to extensive strain on health systems. The integration of mental health workers into primary care has been proposed as one possible solution, but evidence of clinical and cost effectiveness of this approach is unclear. We reviewed the clinical and cost effectiveness of mental health workers colocated within primary care practices.
Systematic literature review.
We searched the Medline, Embase, PsycINFO, Healthcare Management Information Consortium (HMIC) and Global Health databases.
All quantitative studies published before July 2019 were eligible for the review; participants of any age and gender were included. Studies did not need to report a certain outcome measure or comparator in order to be eligible.
Data were extracted using a standardised table; however, pooled analysis proved unfeasible. Studies were assessed for risk of bias using the Risk Of Bias In Non-randomised Studies - of Interventions (ROBINS-I) tool and the Cochrane collaboration's tool for assessing risk of bias in randomised trials.
Fifteen studies from four countries were included. Mental health worker integration was associated with mental health benefits to varied populations, including minority groups and those with comorbid chronic diseases. Furthermore, the interventions were correlated with high patient satisfaction and increases in specialist mental health referrals among minority populations. However, there was insufficient evidence to suggest clinical outcomes were significantly different from usual general practitioner care.
While there appear to be some benefits associated with mental health worker integration in primary care practices, we found insufficient evidence to conclude that an onsite primary care mental health worker is significantly more clinically or cost effective when compared with usual general practitioner care. There should therefore be an increased emphasis on generating new evidence from clinical trials to better understand the benefits and effectiveness of mental health workers colocated within primary care practices.
精神健康障碍对全球疾病负担有重大影响，并给卫生系统带来巨大压力。将精神卫生工作者纳入初级保健已被提议作为一种可能的解决方案，但这种方法的临床效果和成本效益的证据尚不清楚。我们回顾了在初级保健机构中与其他科室合署办公的精神卫生工作者的临床效果和成本效益。
系统文献综述。
我们检索了医学期刊数据库（Medline）、荷兰医学文摘数据库（Embase）、心理学文摘数据库（PsycINFO）、医疗保健管理信息联盟（HMIC）和全球健康数据库。
2019年7月之前发表的所有定量研究均符合本综述的要求；纳入任何年龄和性别的参与者。研究不需要报告特定的结局指标或对照即可符合要求。
使用标准化表格提取数据；然而，汇总分析被证明不可行。使用非随机干预性研究的偏倚风险（ROBINS-I）工具和Cochrane协作网评估随机试验偏倚风险的工具对研究进行偏倚风险评估。
纳入了来自四个国家的15项研究。精神卫生工作者的整合给不同人群带来了心理健康益处，包括少数群体和患有慢性合并症的人群。此外，这些干预措施与患者的高满意度以及少数群体中精神科专科转诊人数的增加相关。然而，没有足够的证据表明临床结局与普通全科医生的常规治疗有显著差异。
虽然精神卫生工作者融入初级保健机构似乎有一些益处，但我们发现没有足够的证据得出结论，即与普通全科医生的常规治疗相比，现场的初级保健精神卫生工作者在临床效果或成本效益上更显著。因此，应更加重视从临床试验中获取新的证据，以更好地了解在初级保健机构中与其他科室合署办公的精神卫生工作者的益处和效果。
