VITAM Research Centre for Sustainable Health, Quebec, Quebec, Canada.
Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, Quebec, Canada.
PLoS One. 2022 Jun 10;17(6):e0268649. doi: 10.1371/journal.pone.0268649. eCollection 2022.
BACKGROUND: Collaborative care is an evidence-based approach to improving outcomes for common mental disorders in primary care. Efforts are underway to broadly implement the collaborative care model, yet the extent to which this model promotes person-centered mental health care has been little studied. The aim of this study was to describe practices related to two patient and family engagement strategies-personalized care planning and shared decision making-within collaborative care programs for depression and anxiety disorders in primary care. METHODS: We conducted an update of a 2012 Cochrane review, which involved searches in Cochrane CCDAN and CINAHL databases, complemented by additional database, trial registry, and cluster searches. We included programs evaluated in a clinical trials targeting adults or youth diagnosed with depressive or anxiety disorders, as well as sibling reports related to these trials. Pairs of reviewers working independently selected the studies and data extraction for engagement strategies was guided by a codebook. We used narrative synthesis to report on findings. RESULTS: In total, 150 collaborative care programs were analyzed. The synthesis showed that personalized care planning or shared decision making were practiced in fewer than half of programs. Practices related to personalized care planning, and to a lesser extent shared decision making, involved multiple members of the collaborative care team, with care managers playing a pivotal role in supporting patient and family engagement. Opportunities for quality improvement were identified, including fostering greater patient involvement in collaborative goal setting and integrating training and decision aids to promote shared decision making. CONCLUSION: This review suggests that personalized care planning and shared decision making could be more fully integrated within collaborative care programs for depression and anxiety disorders. Their absence in some programs is a missed opportunity to spread person-centered mental health practices in primary care.
背景：协作式护理是一种基于证据的方法，可改善初级保健中常见精神障碍的治疗效果。目前正在努力广泛实施协作式护理模式，但该模式在促进以患者为中心的精神卫生保健方面的程度却鲜少被研究。本研究旨在描述在初级保健中针对抑郁和焦虑障碍的协作式护理方案中与两种患者和家庭参与策略（个性化护理计划和共同决策）相关的实践。
方法：我们对 2012 年 Cochrane 综述进行了更新，该综述涉及在 Cochrane CCDAN 和 CINAHL 数据库中的检索，并辅以其他数据库、试验登记处和聚类搜索。我们纳入了针对成年或青少年被诊断为抑郁或焦虑障碍的临床试验中评估的方案，以及与这些试验相关的兄弟姐妹报告。独立工作的两位评审员选择研究，并根据代码簿指导对参与策略进行数据提取。我们使用叙述性综合报告结果。
结果：总共分析了 150 个协作式护理方案。综合结果表明，个性化护理计划或共同决策的实施不到一半的方案。个性化护理计划的实施情况，以及在较小程度上的共同决策，涉及协作式护理团队的多个成员，其中护理经理在支持患者和家庭参与方面发挥着关键作用。确定了质量改进的机会，包括促进患者更多地参与协作目标设定，并整合培训和决策辅助工具以促进共同决策。
结论：本综述表明，个性化护理计划和共同决策可以更充分地整合到针对抑郁和焦虑障碍的协作式护理方案中。在一些方案中缺乏这些策略是在初级保健中推广以患者为中心的精神卫生实践的错失机会。
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