Centre for Primary Health Care and Equity, University of New South Wales, Sydney, New South Wales, Australia.
Susan Wakil School of Nursing, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales , Australia.
BMC Health Serv Res. 2023 Sep 11;23(1):977. doi: 10.1186/s12913-023-09918-2.
People with serious mental illness die about 20 years earlier than the general population from preventable diseases. Shared-care arrangements between general practitioners and mental health services can improve consumers' access to preventive care, but implementing shared care is challenging. This scoping review sought to describe current evidence on the barriers and facilitators to the participation and engagement of primary care (specifically general practitioners) in shared-care arrangements with community mental health services for preventive health care of this population.
We searched Medline, Embase, CINAHL, Scopus, APA PsychINFO and EBM Reviews from 2010 to 2022. Data was extracted against a Microsoft Excel template developed for the review. Data was synthesised through tabulation and narrative methods.
We identified 295 records. After eligibility screening and full-text review, seven studies were included. Facilitators of engagement included a good fit with organisation and practice and opportunities to increase collaboration, specific roles to promote communication and coordination and help patients to navigate appointments, multidisciplinary teams and teamwork, and access to shared medical/health records. Barriers included a lack of willingness and motivation on the part of providers and low levels of confidence with tasks, lack of physical structures to produce capacity, poor alignment of funding/incentives, inability to share patient information and challenges engaging people with severe mental illness in the service and with their care.
Our results were consistent with other research on shared care and suggests that the broader literature is likely to be applicable to the context of general practitioner/mental health services shared care. Specific challenges relating to this cohort present difficulties for recruitment and retention in shared care programs. Sharing "goals and knowledge, mutual respect" and engaging in "frequent, timely, accurate, problem-solving communication", supported by structures such as shared information systems are likely to engage primary care in shared care arrangements more than the traditional focus on incentives, education, and guidelines.
严重精神疾病患者的死亡人数比一般人群早 20 年，其死因是可预防的疾病。全科医生和精神卫生服务机构之间的共同照护安排可以改善患者获得预防保健的机会，但实施共同照护具有挑战性。本范围综述旨在描述当前关于初级保健（特别是全科医生）参与和参与社区精神卫生服务机构共同照护安排以进行该人群预防保健的障碍和促进因素的证据。
我们检索了 2010 年至 2022 年期间的 Medline、Embase、CINAHL、Scopus、APA PsychINFO 和 EBM Reviews。使用为该综述开发的 Microsoft Excel 模板提取数据。通过制表和叙述方法对数据进行综合。
我们确定了 295 条记录。经过资格筛选和全文审查，纳入了 7 项研究。参与的促进因素包括与组织和实践的良好契合度，以及增加合作的机会、促进沟通和协调以及帮助患者预约的特定角色、多学科团队和团队合作，以及获取共享的医疗/健康记录。障碍包括提供者缺乏意愿和动力，以及对任务的信心不足，缺乏产生能力的物理结构，资金/激励措施的不一致，无法共享患者信息，以及在服务中以及在与他们的护理中难以接触到严重精神疾病患者。
我们的研究结果与其他关于共同照护的研究一致，并表明更广泛的文献可能适用于全科医生/精神卫生服务共同照护的背景。与该队列相关的具体挑战给共同照护计划的招募和保留带来了困难。共享“目标和知识、相互尊重”，并进行“频繁、及时、准确、解决问题的沟通”，并辅以共享信息系统等结构，可能比传统的关注激励措施、教育和指南更能使初级保健参与共同照护安排。
