Table 1 Evidence for the benefits of shared care
From: Shared care in mental illness: A rapid review to inform implementation
| Benefit | Supporting evidence |
|---|---|
| Access and Equity | • Improved access by reducing barriers to availability of integrated care with primary care or improved access to specialist care (Druss 2001, Harrison-Read 2002, PRISM-E, van Orden 2009). |
| • Improved access to outpatient services, rehab services, and an increase the number of people receiving follow-up, case management and review of their medication (Byng 2004, Gilmer 2010, Rosenheck 2003) | |
| • Increased ability to target high priority groups through tailored programs linked with relevant services (e.g. cultural groups, age-based services, homelessness) (Asanow 2009, Gilmer 2010, Rosenheck 2003) | |
| • Reduced impact of perceived stigma on help seeking for mental health problems (PRISM-E, Gavin 2008) | |
| Acceptability and stigma | • Reduced unmet need for treatment (PRISM-E (73% of participants)) |
| • Improved cultural appropriateness of service (IMPACT, PRISM-E) | |
| Comprehensiveness | • Increased efficacy of pharmacological/psychological treatments in primary care. Treatment course is generally predictable and with good step up/step down algorithms (IMPACT, PROSPECT,CALM, Bower 2006, Gilbody 2006)) |
| • Capacity to match intensity of intervention to patient need (stepped care) (IMPACT, PROSPECT, CALM) | |
| • Improved capacity of generalist services to meet full range of patient needs (IMPACT, PRISM-E) | |
| • Improved communication between levels of care (primary and specialist) (Craven 2006, PRISM-E) | |
| • Improved capacity to address mental health aspects of physical illness and chronic disease (Byng 2004, Druss 2001, Gilmer 2010, Rosenheck 2003, PRISM-E, IMPACT) | |
| • Improved skill of generalist health worker in mental health care (Fuller 2009) | |
| • Considers client preference in the choice of care delivered (IMPACT, CALM) | |
| • Promotes engagement in care (e.g. via link worker) (Byng 2004, Oxman 2003) | |
| Continuity | • Single point of contact to review care progress and needs (e.g. through primary care) (Druss 2001, PRISM-E) |
| Outcomes: clinical, functional. social | • Evidence of improved clinical outcomes (psychiatric) (Bauer 2006, Bertelsen 2008, Bower 2006, Fuller 2009, Gilbody 2006, Simon 2006, PRISM-E (6 mths only), IMPACT, PROSPECT, RESPECT-D, CALM) |
| • Evidence of improved clinical outcomes (physical and medical) (Druss 2001, IMPACT) | |
| • Evidence of reduced hospitalisation for mental health problem (Bauer 2009) | |
| • Evidence of improved social functioning and/or quality of life (Bauer 2009, Gilmer 2010, Rosenheck 2003, IMPACT) | |
| • Greater satisfaction with care (Asarnow 2009 (6 months), Bauer 2009, Gilmer 2010, Rosenheck 2003, PRISM-E, IMPACT, RESPECT-D) | |
| • Increased ability of consumers to manage their own care (IMPACT) | |
| • Reduced or equal client costs (Bauer 2006, Bower 2006, Druss 2001, Katon 2002, van Orden 2009) | |
| Cost 1 | • Increased health care costs of initial set-up (first 12 months) balanced against cost savings in following year (Katon 2002, Katon 2006, Simon 2007) |
| • Reduced in-patient costs (Bauer 2009, Byng 2004, Druss 2001) | |
| • Cost-offset effects on non-mental health-related ambulatory care services (IMPACT) | |
| • Reduction in costs to other systems (e.g. justice) (Gilmer 2010, Rosenheck 2003) |