Abdulla Saira, Kramer Sherianne, Robertson Lesley, Mhlanga Samantha, Zharima Campion, Goudge Jane
Centre for Health Policy, School of Public Health, University of Witwatersrand, Private Bag X3 Wits 2050, Johannesburg, South Africa.
Department of Psychiatry, University of Witwatersrand, Johannesburg, South Africa.
Community Ment Health J. 2025 Mar 27. doi: 10.1007/s10597-025-01459-8.
Community-based collaborative care (CBCC) is an effective approach for addressing the needs of people with mental health conditions. However, even with the established components of CBCC in place, CBCCs effectiveness for serious mental illnesses (SMIs) remains unknown. This review aims to synthesize qualitative evidence of health care providers' experiences of CBCC in order to identify key factors that facilitate or hinder collaboration in the specific context of SMIs. We searched databases to identify 3368 studies. The eligibility criteria included qualitative studies focusing on health care providers' experiences in delivering a CBCC intervention for people with SMIs. Studies were included if they had at least 2 of 3 CBCC components: a multidisciplinary team, case management, and structured communication. Thematic analysis was used to synthesise the findings, and the Standards for Reporting Qualitative Research framework was used to assess the quality of included studies. The protocol is registered on Prospero. Of the 19 studies included in our review, 5 had achieved collaboration, which was driven by several key ingredients: the availability of on-site case managers and psychiatrists, or the psychiatrists' willingness to travel to the site; the psychiatrists' efforts in actively engaging and supporting the CBCC team; the primary care clinicians' willingness to collaborate with the team and reduce traditional hierarchical engagement; the team's understanding of CBCC; and case managers with strong interpersonal and professional skills. The inclusion of CBCC components do not guarantee collaboration. The findings emphasise the importance of on-site mental health specialists, clearly defined roles, and proactive providers in achieving collaboration.
基于社区的协作护理（CBCC）是满足心理健康状况患者需求的有效方法。然而，即使CBCC的既定组成部分已经到位，其对严重精神疾病（SMI）的有效性仍然未知。本综述旨在综合医疗保健提供者对CBCC体验的定性证据，以确定在SMI的特定背景下促进或阻碍协作的关键因素。我们检索数据库以识别3368项研究。纳入标准包括聚焦医疗保健提供者为SMI患者提供CBCC干预体验的定性研究。如果研究具备3个CBCC组成部分中的至少2个，即多学科团队、病例管理和结构化沟通，则纳入研究。采用主题分析法对研究结果进行综合，并使用定性研究报告标准框架评估纳入研究的质量。该方案已在国际系统评价注册库Prospero上注册。在我们综述纳入的19项研究中，有5项实现了协作，这得益于几个关键因素：现场病例管理人员和精神科医生的可及性，或者精神科医生前往现场的意愿；精神科医生积极参与并支持CBCC团队的努力；基层医疗临床医生与团队协作并减少传统等级参与的意愿；团队对CBCC的理解；以及具备强大人际和专业技能的病例管理人员。纳入CBCC组成部分并不能保证协作。研究结果强调了现场心理健康专家、明确界定的角色以及积极主动的提供者在实现协作方面的重要性。
