Evaluation of a collaborative care model for integrated primary care of common mental disorders comorbid with chronic conditions in South Africa
Open Access
- 3 April 2019
- journal article
- research article
- Published by Springer Science and Business Media LLC in BMC Psychiatry
- Vol. 19 (1), 1-11
- https://doi.org/10.1186/s12888-019-2081-z
Abstract
The rise in multimorbid chronic conditions in South Africa, large treatment gap for common mental disorders (CMDs) and shortage of mental health specialists demands a task sharing approach to chronic disease management that includes treatment for co-existing CMDs to improve health outcomes. The aim of this study was thus to evaluate a task shared integrated collaborative care package of care for chronic patients with co-existing depressive and alcohol use disorder (AUD) symptoms. The complex intervention strengthened capacity of primary care nurse practitioners to identify, diagnose and review symptoms of CMDs among chronic care patients; and implemented a stepped up referral system, that included clinic-based psychosocial lay counsellors, doctors and mental health specialists. Under real world conditions, in four PHC facilities, a repeat cross-sectional Facility Detection Survey (FDS) assessed changes in capacity of nurses to correctly detect CMDs in 1310 patients before implementation and 1246 patients following implementation of the intervention at 12 months; and a non-randomly assigned comparison group cohort study comprising 373 screen positive patients with depressive symptoms using the Patient Health Questionnaire-9 (PHQ9) at baseline, evaluated responses of patients correctly identified and referred for treatment (intervention arm) or not identified and referred (control arm) at three and 12 months. The FDS showed a significant increase in the identification of depression and AUD from pre-implementation to 12-month post-implementation. Depression: (5.8 to 16.4%) 95% CI [2.9, 19.1]); AUD: (0 to 13.8%) 95% CI [0.6–24.9]. In the comparison group cohort study, patients with depressive symptoms having more than a 50% reduction in PHQ-9 scores were greater in the treatment group (n = 69, 55.2%) compared to the comparison group (n = 49, 23.4%) at 3 months (RR = 2.10, p < 0.001); and 12 months follow-up (intervention: n = 57, 47.9%; comparison: n = 60, 30.8%; RR = 1.52, p = 0.006). Remission (PHQ-9 ≤ 5) was greater in the intervention group (n = 32, 26.9%) than comparison group (n = 33, 16.9%) at 12 months (RR = 1.72, p = 0.016). A task shared collaborative stepped care model can improve detection of CMDs and reduce depressive symptoms among patients with chronic conditions under real world conditions.Keywords
Funding Information
- Department for International Development (201446)
This publication has 29 references indexed in Scilit:
- Grand Challenges: Integrating Mental Health Services into Priority Health Care PlatformsPLoS Medicine, 2013
- PRIME: A Programme to Reduce the Treatment Gap for Mental Disorders in Five Low- and Middle-Income CountriesPLoS Medicine, 2012
- Alcohol Consumption, Progression of Disease and Other Comorbidities, and Responses to Antiretroviral Medication in People Living with HIVAIDS Research and Treatment, 2012
- Community-Based Mental Health Intervention for Underprivileged Women in Rural India: An Experiential ReportInternational Journal of Family Medicine, 2011
- Alcohol use as a risk factor for tuberculosis – a systematic reviewBMC Public Health, 2008
- Twelve-month treatment of psychiatric disorders in the South African Stress and Health Study (World Mental Health Survey Initiative)Social psychiatry. Sozialpsychiatrie. Psychiatrie sociale, 2008
- Common Mental Disorders among HIV-Infected Individuals in South Africa: Prevalence, Predictors, and Validation of Brief Psychiatric Rating ScalesAIDS Patient Care and STDs, 2008
- Integrating Mental Health and Primary CarePrimary Care: Clinics in Office Practice, 2007
- Meta-Analysis of the Relationship Between HIV Infection and Risk for Depressive DisordersAmerican Journal of Psychiatry, 2001
- Comprehensive integrated primary mental health care for South Africa. Pipedream or possibility?Social Science & Medicine (1982), 2000