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. 2019 Apr 3;19(1):107.
doi: 10.1186/s12888-019-2081-z.

Evaluation of a collaborative care model for integrated primary care of common mental disorders comorbid with chronic conditions in South Africa

Inge Petersen  1 , Arvin Bhana  2   3 , Lara R Fairall  4 , One Selohilwe  2 , Tasneem Kathree  2 , Emily C Baron  5 , Sujit D Rathod  6 , Crick Lund  5   7
Affiliations

Evaluation of a collaborative care model for integrated primary care of common mental disorders comorbid with chronic conditions in South Africa

Inge Petersen et al. BMC Psychiatry. .

Abstract

Background: 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.

Methods: 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.

Results: 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).

Conclusion: 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: Chronic care; Collaborative care; Common mental disorders; Lay counsellors; South Africa; Task sharing.

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Conflict of interest statement

Ethics approval and consent to participate

Ethical approvals for the FDS and Cohort studies were obtained from the University of KwaZulu-Natal (South Africa) Biomedical Research Ethics Committee (BE400/13; BE258/14; BE372/13), the University of Cape Town (South Africa) Faculty of Health Sciences Human Research Ethics Committee (HREC REF 412/2011), and the World Health Organization (Geneva, Switzerland) Research Ethics Review Committee (RPC497). In relation to participant safety concerns, patients who responded positively to the PHQ-9 suicide ideation question were referred by the fieldworkers to clinic nurses for further assessment and onward referral, if necessary. Written informed consent was obtained from literate participants and illiterate participants consented by marking the form with a cross; with a witness countersigning.

Consent for publication

Not applicable.

Competing interests

The authors declare they have no Competing interest.

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References

    1. Moussavi S, Chatterji S, Verdes E, Tandon A, Patel V, Ustun B. Depression, chronic diseases, and decrements in health: results from the world health surveys. Lancet. 2007;370(9590):851–858. doi: 10.1016/S0140-6736(07)61415-9. - DOI - PubMed
    1. Ciesla JA, Roberts JE. Meta-analysis of the relationship between HIV infection and risk for depressive disorders. Am J Psychiatry. 2001;158(5):725–730. doi: 10.1176/appi.ajp.158.5.725. - DOI - PubMed
    1. Neuman MG, Schneider M, Nanau RM, Parry C. Alcohol consumption, progression of disease and other comorbidities, and responses to antiretroviral medication in people living with HIV. AIDS research and treatment. 2012;2012:751827. doi: 10.1155/2012/751827. - DOI - PMC - PubMed
    1. Lonnroth K, Williams BG, Stadlin S, Jaramillo E, Dye C. Alcohol use as a risk factor for tuberculosis - a systematic review. BMC Public Health. 2008;8:289. doi: 10.1186/1471-2458-8-289. - DOI - PMC - PubMed
    1. Naylor C, Parsonage M, McDaid D, Knapp M, Fossey M, Galea A. The cost of co-morbidities. London: The Kings Fund; 2012. Long-term conditions and mental health.

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