The role of boundary spanners in delivering collaborative care: a process evaluation.

Anne McBride,Michael Spence,Carianne M. Hunt

doi:10.1186/s12875-016-0501-4

Abstract

BackgroundOn average, people with schizophrenia and psychosis die 13–30 years sooner than the general population (World Psychiatry 10 (1):52–77, 2011). Mental and physical health care is often provided by different organisations, different practitioners and in different settings which makes collaborative care difficult. Research is needed to understand and map the impact of new collaborative ways of working at the primary/secondary care interface (PloS One 7 (5); e36468). The evaluation presented in this paper was designed to explore the potential of a Community and Physical Health Co-ordinator role (CPHC) (CPHCs were previously Care Co-ordinators within the Community Mental Health Team, Community in the title CPHC refers to Community Mental Health) and Multi-Disciplinary Team (MDT) meetings across primary and community care, with the aim of improving collaboration of mental and physical health care for service users with Severe Mental Illness (SMI).MethodsData collection took place across five general practices (GPs) and a Community Mental Health Team (CMHT) in the Northwest of England, as part of a process evaluation. Semi-structured interviews were conducted with a purposive sample of GP staff (n= 18) and CMHT staff (n=4), a focus group with CMHT staff (n=8) and a survey completed by 13 CMHT staff, alongside cardiovascular risk data and MDT actions. Framework analysis was used to manage and interpret data.ResultsThe results from the evaluation demonstrate that a CPHC role and MDT meetings are effective mechanisms for improving the collaboration and co-ordination of physical health care for SMI service users. The findings highlight the importance of embedding and supporting the CPHC role, with an emphasis on protected time and continuing professional roles and integrating multiple perspectives through MDT meetings. Considering the importance of physical health care for SMI service users and the complex environment, these are important findings for practitioners, researchers and policy makers in the field of primary care and mental health.ConclusionThere is an increasing focus on integration and collaborative working to ensure the delivery of quality care across the whole patient pathway, with a growing need for professionals to work together across service and professional boundaries. The introduction of a two pronged approach to collaboration has shown some important improvements in the management of physical health care for service users with SMI.

Highlights

On average, people with schizophrenia and psychosis die 13–30 years sooner than the general population (World Psychiatry 10 (1):52–77, 2011)
The findings presented in this paper describe how a Community and Physical Health Co-ordinator role (CPHC) role and MultiDisciplinary Team (MDT) meetings can work across the boundaries of primary and community care, facilitating the sharing and integration of information within and across services
The CPHC an embedded boundary spanner Prior to the CPHC role communication between primary and community care was ‘patchy’, ‘sporadic’ and ‘disjointed’, which led to limited co-ordination across services

Summary

Introduction

People with schizophrenia and psychosis die 13–30 years sooner than the general population (World Psychiatry 10 (1):52–77, 2011). People with mental health problems, such as schizophrenia or bipolar disorder, die on average 13–30 years sooner than the general population [1, 2,3,4] This mortality gap has widened in recent decades [5,6,7] and approximately 60 % is due to physical illness [8, 9]. There is an enormous gap in physical health outcomes for those with mental health problems and, as such, more needs to be done to promote and manage good mental health and prevent mental ill health [12] These inequalities are attributed to a combination of factors, one of which being the separation of mental health services from other medical services [13, 14] and poor clarity regarding responsibility in care co-ordination [15]. The increased prevalence of cardiovascular disease and its modifiable risk factors highlights the importance of ensuring that people with SMI are monitored and screened regularly

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Discussion

Conclusion