Effectiveness Of Collaborative Care Model Research Articles

The effect of collaborative care model on quality of life and anxiety in patients with leukemia

Background and Objective: Leukemia is one of the top five cancers in Iran. Aside from physical issues, the disease causes a variety of social and psychological issues for patients. In this regard, one aspect that cancer may affect is quality of life, which can lead to anxiety. The collaborative care model is a novel nursing model that improves treatment outcomes through collaboration. As a result, the purpose of this study is to look into the impact of a collaborative care model on quality of life and anxiety in leukemia patients.Methods: The current non-randomized clinical trial, which included a control group, was conducted on 60 leukemia patients at Firoozgar and Rasoul Akram hospitals in Tehran (affiliated to Iran University of Medical Sciences). The hospitals were randomly divided into two groups: control and intervention, and patients were chosen at random from each hospital using a convenience sampling method. The collaborative care model was implemented in the intervention group, while no specific measures were taken in the control group. Patients in both groups' quality of life was measured using the Quality-of-Life Questionnaire in Oncology Patients before, one, and two months after the intervention, and their anxiety was measured using the Beck Anxiety Inventory. Both groups completed their questionnaires using a self-report method.Results: In terms of demographic characteristics, there was no statistically significant difference between the two groups (p>0.05). Prior to the intervention, no statistically significant difference in mean anxiety, quality of life, and its dimensions was observed between the two groups (p>0.05). Following the intervention, a statistically significant difference in mean anxiety and quality of life scores was observed between the two groups (p<0.05), indicating a decrease in anxiety and an increase in quality of life among patients in the intervention group.Conclusion: Based on the findings, it appears that the collaborative care model has a positive effect on reducing anxiety and improving quality of life in leukemia patients, and it is preferable to use this model when caring for this group of patients.

Managing Depression in Diabetes Mellitus: A Multicentric Randomized Controlled Trial Comparing Effectiveness of Fluoxetine and Mindfulness in Primary Care: Protocol for DIAbetes Mellitus ANd Depression (DIAMAND) Study.

Background:Suboptimal management of depression in type 2 diabetes mellitus (T2DM) often translates into poor glycemic control, medical complications, and impaired quality of life. Feasibility and effectiveness of collaborative care models of depression in diabetes in low- and middle-income countries (LMICs) remain unexplored. DIAbetes Mellitus ANd Depression (DIAMAND) study, a multicentric single-blind randomized controlled trial (SBRCT) comparing effectiveness of fluoxetine and mindfulness in primary care settings, addresses this gap in scientific literature.Methods:This trial conducted in diverse geographic settings of New Delhi, Bengaluru, and Bhubaneswar will comprise module-based training of primary care providers (PCPs) for screening, diagnosing, and managing depression in diabetes in phase I. Phase II will involve four-arm parallel group RCT on 350 participants with T2DM with comorbid depressive episode randomly allocated to receive fluoxetine, mindfulness therapy, fluoxetine plus mindfulness therapy, or treatment as usual at primary care settings. Interventions would include fluoxetine (up to 60 mg/day) and/or sessions of mindfulness for 16 weeks. Primary outcomes on standardized rating scales include depression scores (Hamilton Depression Rating Scale), treatment adherence (Adherence to Refill and Medication Scale), self-care (Diabetes Self-Management Questionnaire), diabetes-related distress (Diabetes Distress Scale), and glycemic control. Secondary outcomes include quality of life (World Health Organization Quality of Life Brief version [WHO-QOL BREF]) and mindfulness (Five Facets Mindfulness Questionnaire).Discussion:This RCT will investigate the effectiveness of module-based training of PCPs and feasibility of collaborative care model for managing depression in T2DM in primary care settings in LMICs and effectiveness of fluoxetine and/or mindfulness in improving diverse outcomes of T2DM with major depression.

Collaborative Care Model Based Telerehabilitation Exercise Training Program for Acute Stroke Patients in China: A Randomized Controlled Trial

BackgroundEarly rehabilitation has been proved very important for stroke patients. However, the effective model of transitioning from early in-hospital rehabilitation to discharge rehabilitation using the collaborative remote rehabilitation nursing model has not been thoroughly studied. ObjectiveTo explore the feasibility and effectiveness of collaborative care model based telerehabilitation exercise training for acute stroke patients. MethodsA randomized controlled clinical trial was conducted. Patients were recruited and randomly divided into intervention and control group. Both groups were given regular treatment and acute rehabilitation nursing instructions during hospitalization. The control group was followed by regular telephone follow-up after discharge. The intervention group received Internet-based remote rehabilitation project after discharge. Motor function, balance ability and quality of life were measured at the day of discharge, the 4th week, 8th week and 12th week after patients were discharged. The CONSORT checklist was used to check the procedure. ResultsA total of 61 patients completed the study, 30 cases in the intervention group and 31 cases in the control group. Both groups were significantly improved in terms of motor function and quality of life, but the intervention group showed greater improvement in Fugl-Meyer Motor Function Assessment (intervention group = 83.70 ± 4.44, control group = 75.29 ± 2.89), Berg Balance Scale (intervention group = 43.13 ± 2.32, control group = 38.29 ± 2.70) and Stroke-Specific Quality of Life Scale (intervention group = 190.57 ± 5.09, control group = 175.90 ± 5.78). Group-time interaction was significant in motor function and quality of life. ConclusionCollaborative care model based telerehabilitation exercise training program can safely and effectively improve the recovery of motor function and improve the quality of life in patients with stroke.

Evaluation of the Effectiveness of Collaborative Care Model on the Quality of Life and Metabolic Indexes in Patients with Type 2 Diabetes

Background and Objective: Educating patients plays an important role in improving their quality of life. The collaborative care model is a new method of self-care training. This study was conducted to evaluate the effect of collaborative care model on the quality of life and metabolic control indexes in patients with type 2 diabetes. Materials and Methods: In this semi-experimental study, 60 patients with type 2 diabetes visiting diabetes clinic of Jiroft Hospital were studied. The participants were selected based on the convenience sampling method. To implement the collaborative model that included four stages of motivation, preparation, engagement, and evaluation, the patients were divided into four groups, and the model was executed for three months for each group. Data collection tools included a researcher-made questionnaire including demographic characteristics, metabolic indexes and vital signs and the quality of life questionnaire for patients with diabetes. The collected data were analyzed using Wilcoxon, Mac-Nemar and paired t-test in SPSS, version 20. Results: After performing the collaborative care model, the total mean quality of life increased from 50.7±5.7 to 68.3 ±5.2. The results of Wilcoxon test showed a significant difference in care and metabolic indexes (P<0.001). The quality of life improved in different dimensions compared to the pre-intervention stage (P<0.001). Conclusion: The implementation of this model improves the quality of life and metabolic indexes. Therefore, the use of collaborative care model as an effective model for educating patients with type 2 diabetes is recommended.

The Effect of Collaborative Care Model on Social Support and General Self-Efficacy of the Elderly

The Effect of Collaborative Care Model on Social Support and General Self-Efficacy of the Elderly

Effects of Collaboration Care Model on the Quality of Life in Patients after Coronary Angioplasty: A Randomized Controlled Clinical Trial.

Coronary artery diseases and therapies such as coronary angioplasty would lead to changes in the quality of life in patients. The aim of this study was to determine the effects of collaborative care model on the quality of life in patients after coronary angioplasty. This randomized controlled clinical trial was conducted in Isfahan, Iran during 2015. In this study, 50 samples were selected by simple sampling and randomly allocated into two equal groups of intervention and control. Collaborative care model was performed in the intervention group for 3 months. Data were collected using quality of life (SF-36) questionnaire which includes 36 questions on physical and psychological dimensions and was completed before and one month after the intervention in both groups. Data were analyzed using descriptive and analytical statistics and by independent t- test, paired t test, Chi square and Mann-Whitney tests through SPSS 18. After the intervention, the mean score of quality of life in the intervention group was significantly higher than the control group (P<0.05). The results of independent t-test showed a significant difference between both groups regarding the mean of changes in the score of quality of life and its dimensions in patients undergoing coronary angioplasty 3 months after the intervention (P<0.001). Results revealed that patients who had been cared based on collaborative care model had better scores of quality of life in all the physical, mental and social dimensions than the control group. Therefore, using this model for taking care of patients after coronary angioplasty is recommended. Trial Registration Number: IRCT2015120120912N4.

Effect of collaboration care model on diseases attitude and self-efficacy of patients with chronic hepatitis B

Objective To investigate the effect of collaborative care model on diseases attitude and self-efficacy of patients with chronic hepatitis B. Methods Ninety-six cases of patients with chronic hepatitis B were selected. Forty-seven cases who were hospitalized from June 2015 to December 2015 were seemed as the control group, while 49 cases who were hospitalized from January 2016 to June 2016 were seemed as the collaboration group. Patients in control group were accepted routine care measures for chronic hepatitis B. Patients in collaboration group were accepted collaboration care measure on the basis of routine care, including patient assessment and collaboration care program development, health knowledge for patients and their families guiding and basic skills training, and psychological guidance intervention. Respectively, at admitting to hospital and after intervention 4 weeks, the diseases attitude of patients with chronic hepatitis B diseases, self-care ability and self-efficacy were assessed. Results There were no significant differences in attitude score, self-care ability score, self-efficacy score before intervention between two groups (P > 0.05). They were improved after intervention compared with before intervention, the difference was statistically significant (t = 3.197 -25.376, P < 0.01 or 0.05). The attitude in the face, avoid and give up score respectively in collaborative nursing group after intervention were(28.2±5.3), (9.8±4.2), (5.1±1.7) points, and (23.4±4.1), (14.1±3.8), (8.2±1.9) points in control group, the difference was statistically significant (t = 4.393, 4.220, 9.285, P < 0.01). The health knowledge of self-care ability, self-care skill, since the sense of responsibility, self-concept scale in collaborative nursing group after intervention were (48.2±3.4), (39.5±4.0), (33.1±5.5), (29.1±3.7) points, and (39.4±4.2), (30.2±3.5), (24.7±4.8), (25.2±3.5) points in control group, the difference was statistically significant (t = 5.137-11.286, P < 0.01). The self-efficacy in each entry score and total score in collaborative nursing group were (3.4±0.7), (31.5±4.6) points and (2.8±0.4), (20.7±5.1) points in control group, the difference were statistically significant (t = 5.288, 14.579, P < 0.01). Conclusions Collaborative care model could help chronic hepatitis B patients to establish correct disease attitude, improve self-care ability and enhance self-efficacy. Key words: Hepatitis B, chronic; Collaborative care; Disease attitude; Self-efficacy

Collaborative care model improves self-care ability, quality of life and cardiac function of patients with chronic heart failure.

Chronic heart failure (CHF) is a common chronic disease that requires much care. This study aimed to explore the effects of collaborative care model (CCM) on patients with CHF. A total of 114 CHF patients were enrolled in this study, and were randomly and equally divided into two groups: control and experimental. Patients in the two groups received either usual care or CCM for 3 continuous months. The impacts of CCM on the self-care ability and quality of life were assessed using self-care of heart failure index and short form health survey 12, respectively. Further, cardiac function was assessed by measuring left ventricular ejection fraction (LVEF) and the level of N-terminal pro-B-type natriuretic peptide (NT-proBNP), and by the 6-min walking test. Clinical and demographic characteristics of patients in the control and CCM groups were statistically equivalent. Compared with usual care, CCM significantly enhanced self-care abilities of patients with CHF, including self-care maintenance, self-care management and self-care confidence (all P<0.05). The physical and mental quality of life was also significantly improved by CCM (P<0.01 or P<0.05). Compared with usual care, CCM significantly increased the LVEF (P<0.01), decreased the NT-proBNP level (P<0.01), and enhanced exercise capacity (P<0.001). In conclusion, CCM improved the self-care, quality of life and cardiac function of patients with CHF compared with usual care.

Collaborative Care in Schools: Enhancing Integration and Impact in Youth Mental Health.

Collaborative Care is an innovative approach to integrated mental health service delivery that focuses on reducing access barriers, improving service quality, and lowering healthcare expenditures. A large body of evidence supports the effectiveness of Collaborative Care models with adults and, increasingly, for youth. Although existing studies examining these models for youth have focused exclusively on primary care, the education sector is also an appropriate analog for the accessibility that primary care offers to adults. Collaborative Care aligns closely with the practical realities of the education sector and may represent a strategy to achieve some of the objectives of increasingly popular multi-tiered systems of supports frameworks. Unfortunately, no resources exist to guide the application of Collaborative Care models in schools. Based on the existing evidence for Collaborative Care models, the current paper (1) provides a rationale for the adaptation of Collaborative Care models to improve mental health service accessibility and effectiveness in the education sector; (2) presents a preliminary Collaborative Care model for use in schools; and (3) describes avenues for research surrounding school-based Collaborative Care, including the currently funded Accessible, Collaborative Care for Effective School-based Services (ACCESS) project.

Effects of collaborative care model on negative emotions and quality of life of patients with chronic heart failure

Objective To explore the effects of collaborative care model on negative emotions and quality of life of patients with chronic heart failure. Methods A total of 120 patients with chronic heart failure between January 2013 and January 2015 in our hospital were selected and randomly divided into control group (60 cases) and observation group (60 cases). The observation group was given collaborative care and control group received routine care. The negative emotions and quality of life were evaluated by self-rating depression scale (SDS), self-rating anxiety scale (SAS) and Minnesota living with heart failure questionaire (MLHFQ) at admission, discharge and 6 months after discharge. Results The scores of SDS and SAS in observation group were lower than those in control group at discharge and 6 months after discharge. The differences between two groups were statistically significant (P<0.05). The score of MLHFQ in observation group was also lower than that in control group 6 months after discharge [(48.48±8.79) vs. (59.31±9.52)]. The difference between two groups was statistically significant (t=5.78, P<0.05). Conclusions Collaborative care can alleviate the symptoms of anxiety and depression, improve the quality of life of patients with chronic heart failure. Key words: Chronic heart failure; Emotion; Quality of life; Collaborative care model

The effectiveness of an integrated collaborative care model vs. a shifted outpatient collaborative care model on community functioning, residential stability, and health service use among homeless adults with mental illness: a quasi-experimental study.

BackgroundAlthough a growing number of collaborative mental health care models have been developed, targeting specific populations, few studies have utilized such interventions among homeless populations. This quasi-experimental study compared the outcomes of two shelter-based collaborative mental health care models for men experiencing homelessness and mental illness: (1) an integrated multidisciplinary collaborative care (IMCC) model and (2) a less resource intensive shifted outpatient collaborative care (SOCC) model.MethodsIn total 142 participants, 70 from IMCC and 72 from SOCC were enrolled and followed for 12 months. Outcome measures included community functioning, residential stability, and health service use. Multivariate regression models were used to compare study arms with respect to change in community functioning, residential stability, and health service use outcomes over time and to identify baseline demographic, clinical or homelessness variables associated with observed changes in these domains.ResultsWe observed improvements in both programs over time on measures of community functioning, residential stability, hospitalizations, emergency department visits and community physician visits, with no significant differences between groups over time on these outcome measures.ConclusionsOur findings suggest that shelter-based collaborative mental health care models may be effective for individuals experiencing homelessness and mental illness. Future studies should seek to confirm these findings and examine the cost effectiveness of collaborative care models for this population.

The effectiveness of collaborative models of care that facilitate rehabilitation from a traumatic injury: a systematic review

Background Trauma is the most frequent cause of significant functional impairment that leads to the deterioration in health and often delayed functional and psychosocial recovery. Fundamentally, rehabilitation of those with traumatic injuries surpasses the acute management extending into the reintegration of patients to home life and the wider community. Consequently, rehabilitation from a traumatic injury is a multidisciplinary process that incorporates the continuum of care across different settings and organizations. Planning and maintaining effective rehabilitation across organizations and sectors is a significant challenge. Unmet rehabilitation needs can prolong discharge, limit the patient's activities, restrict participation, decrease quality of life and increase dependence on significant others. Objectives The objective of this systematic review was to identify and synthesize the best available evidence on the effectiveness of collaborative care models in relation to traumatic injury rehabilitation. Review question What is the effectiveness of collaborative care models that facilitate rehabilitation from a traumatic injury? Inclusion criteria Types of participants This review considered all studies that included adult patients above 18 years of age and of either gender with a traumatic physical injury requiring rehabilitation across different settings/organizations. Types of interventions Interventions of interest were models of collaborative care that facilitate those rehabilitating from a traumatic physical injury across different care types and settings. The comparator was usual care. Types of studies This review aimed to identify randomized controlled trials; however, with the absence of any randomized controlled trials, other research designs were considered. Types of outcome measures This review considered studies that reported on participation, functionality, quality of life, pain, psychosocial outcomes and goals. Search strategy The search strategy aimed to find both published and unpublished studies without language or publication date restrictions. A three-step search strategy was utilized in this review. Methodological quality The studies were independently assessed by two reviewers using standardized critical appraisal instruments from the Joanna Briggs Institute. Data extraction No studies progressed to data extraction. Data synthesis Data synthesis was not undertaken as no study was identified of sufficient quality. Results This systematic review identified only one paper that met the inclusion criteria. It described the United States Veterans Affair's system of Veteran-centred, post-combat care rehabilitation programs that fundamentally relies on the collaborative care of social workers and nurses to support service members, veterans and their families proceed through the initial recovery, rehabilitation and re-integration into post-combat society and their home communities. Unfortunately, there was no formal evaluation provided that addressed the review's outcomes of interest and therefore the study was excluded. Conclusions This review has highlighted the lack of research concerning collaborative models of care that facilitate rehabilitation from a traumatic injury. It found insufficient data to enable any conclusions to be made about the effectiveness of collaborative models of care that facilitate rehabilitation from a traumatic injury. Implications for clinical practice and research Further research investigating viable collaborative models of care that facilitate the rehabilitation journey across different healthcare sectors is required.

The effectiveness of collaborative models of care that facilitate rehabilitation from a traumatic injury: a systematic review.

Trauma is the most frequent cause of significant functional impairment that leads to the deterioration in health and often delayed functional and psychosocial recovery. Fundamentally, rehabilitation of those with traumatic injuries surpasses the acute management extending into the reintegration of patients to home life and the wider community. Consequently, rehabilitation from a traumatic injury is a multidisciplinary process that incorporates the continuum of care across different settings and organizations. Planning and maintaining effective rehabilitation across organizations and sectors is a significant challenge. Unmet rehabilitation needs can prolong discharge, limit the patient's activities, restrict participation, decrease quality of life and increase dependence on significant others. The objective of this systematic review was to identify and synthesize the best available evidence on the effectiveness of collaborative care models in relation to traumatic injury rehabilitation. What is the effectiveness of collaborative care models that facilitate rehabilitation from a traumatic injury? This review considered all studies that included adult patients above 18 years of age and of either gender with a traumatic physical injury requiring rehabilitation across different settings/organizations. Interventions of interest were models of collaborative care that facilitate those rehabilitating from a traumatic physical injury across different care types and settings. The comparator was usual care. TYPES OF STUDIES: This review aimed to identify randomized controlled trials; however, with the absence of any randomized controlled trials, other research designs were considered. This review considered studies that reported on participation, functionality, quality of life, pain, psychosocial outcomes and goals. The search strategy aimed to find both published and unpublished studies without language or publication date restrictions. A three-step search strategy was utilized in this review. The studies were independently assessed by two reviewers using standardized critical appraisal instruments from the Joanna Briggs Institute. No studies progressed to data extraction. Data synthesis was not undertaken as no study was identified of sufficient quality. This systematic review identified only one paper that met the inclusion criteria. It described the United States Veterans Affair's system of Veteran-centred, post-combat care rehabilitation programs that fundamentally relies on the collaborative care of social workers and nurses to support service members, veterans and their families proceed through the initial recovery, rehabilitation and re-integration into post-combat society and their home communities. Unfortunately, there was no formal evaluation provided that addressed the review's outcomes of interest and therefore the study was excluded. This review has highlighted the lack of research concerning collaborative models of care that facilitate rehabilitation from a traumatic injury. It found insufficient data to enable any conclusions to be made about the effectiveness of collaborative models of care that facilitate rehabilitation from a traumatic injury. IMPLICATIONS FOR CLINICAL PRACTICE AND RESEARCH: Further research investigating viable collaborative models of care that facilitate the rehabilitation journey across different healthcare sectors is required.

The effectiveness of collaborative models of care that facilitate rehabilitation from a traumatic injury: a systematic review protocol.

Trauma is the most frequent cause of significant functional impairment that leads to the deterioration in health and often delayed functional and psychosocial recovery. Fundamentally, rehabilitation of those with traumatic injuries surpasses the acute management extending into the reintegration of patients to home life and the wider community. Consequently, rehabilitation from a traumatic injury is a multidisciplinary process that incorporates the continuum of care across different settings and organizations. Planning and maintaining effective rehabilitation across organizations and sectors is a significant challenge. Unmet rehabilitation needs can prolong discharge, limit the patient's activities, restrict participation, decrease quality of life and increase dependence on significant others.The objective of this systematic review was to identify and synthesize the best available evidence on the effectiveness of collaborative care models in relation to traumatic injury rehabilitation.What is the effectiveness of collaborative care models that facilitate rehabilitation from a traumatic injury?This review considered all studies that included adult patients above 18 years of age and of either gender with a traumatic physical injury requiring rehabilitation across different settings/organizations.Interventions of interest were models of collaborative care that facilitate those rehabilitating from a traumatic physical injury across different care types and settings. The comparator was usual care. TYPES OF STUDIES: This review aimed to identify randomized controlled trials; however, with the absence of any randomized controlled trials, other research designs were considered.This review considered studies that reported on participation, functionality, quality of life, pain, psychosocial outcomes and goals.The search strategy aimed to find both published and unpublished studies without language or publication date restrictions. A three-step search strategy was utilized in this review.The studies were independently assessed by two reviewers using standardized critical appraisal instruments from the Joanna Briggs Institute.No studies progressed to data extraction.Data synthesis was not undertaken as no study was identified of sufficient quality.This systematic review identified only one paper that met the inclusion criteria. It described the United States Veterans Affair's system of Veteran-centred, post-combat care rehabilitation programs that fundamentally relies on the collaborative care of social workers and nurses to support service members, veterans and their families proceed through the initial recovery, rehabilitation and re-integration into post-combat society and their home communities. Unfortunately, there was no formal evaluation provided that addressed the review's outcomes of interest and therefore the study was excluded.This review has highlighted the lack of research concerning collaborative models of care that facilitate rehabilitation from a traumatic injury. It found insufficient data to enable any conclusions to be made about the effectiveness of collaborative models of care that facilitate rehabilitation from a traumatic injury. IMPLICATIONS FOR CLINICAL PRACTICE AND RESEARCH: Further research investigating viable collaborative models of care that facilitate the rehabilitation journey across different healthcare sectors is required.

Effect of collaborative care model on the self-care ability and treatment compliance of pulmonary tuberculosis patients with initial treatment

Objective To discuss the effect of collaborative care model （ CCM） on the self-care ability and treatment compliance of pulmonary tuberculosis patients with initial treatment .Methods A total of 210 pulmonary tuberculosis patients with initial treatment were selected and were randomly divided into the observation group and the control group by using random number table , with 105 patients in each group .The patients in the observation group received CCM , and the patients in the control group received usual care .After being intervened for nine months , the intervention effect was compared by using exercise of self-care agency scale （ ESCA ） and self-designed questionnaire on treatment compliance of patients between the two groups . Results After the intervention, the ESCA total score in the observation group was （108.84 ±177;11.34）, which was higher than that of （ 101 .78 ±177;10 .45 ） in the control group , with statistically significant difference （ t=4.687, P ＜0.05 ）.The number of patients with regular medication , periodical examination of sputum , periodical examination of chest radiograph , and periodical examination of hepatic function was 99,101,102 and 97 in the observation group, respectively, and 86,80,83 and 82 in the control group, respectively, and the differences were statistically significant （χ2 =7.67,12.04,16.39,8.52, respectively; P＜0.05）.The cure rate was 93.33%（98/105） in the observation group, and 82.86% （87/105） in the control group, with statistically significant difference （χ2 =5.49, P＜0.05）.Conclusions The application of CCM can improve the self-care ability and treatment compliance of pulmonary tuberculosis patients with initial treatment . Key words: Tuberculosis,pulmonary; Self-care; Collaborative care model; Treatment compliance

Effects of collaborative care model for the negative mood and quality of life of lung cancer patients

Objective To study the effects of collaborative care model on the negative mood and the quality of life of lung cancer patients. Methods Sixty patients were randomized into the observation group and the control group with 30 cases in each.The control group only received usual care,the observation group Was treated with collaborative care,encouraging patients and their families to participate in health care.Using SDS、SAS、activities of daily living(ADL)scale and St.George's Respiratory Question-naire(SGRQ)to evaluate the effects ofthe patients in both groups on admission and one months after the discharge.Results One months after the discharge,the scores of anxiety and depression among the observation group were lower than those of the control group;ADL grade and quality of life score in the observation group compared with the control group were significantly improved,the difference was statistically significant. Conclusions Application of collaborative care management can improve the state of anxiety and depression,reduce hospitalization time and medical costs as well as improve quality of life. Key words: Collaborative care model; Lung cancer; Anxiety; Depression; Quality of life

Collaborative Care for Depressed Patients With Chronic Medical Conditions: A Randomized Trial in Puerto Rico

Collaborative Care for Depressed Patients With Chronic Medical Conditions: A Randomized Trial in Puerto Rico

Mental health services in metropolitan primary care. The unique challenges and opportunities.

The London Journal of Primary Care intends to publish mental health material that will be relevant to GPs practising in metropolitan areas. We want to harness the knowledge and experience of GPs (nearly 5000 in London alone) and other primary care professionals to contribute to the development of the journal. The importance of primary care for mental health cannot be overestimated. The vast majority of mental illness is managed in primary care.1 Over three quarters of patients consulting their general practitioner admit to at least one psychosocial problem and over one third report that psychosocial problems impact on their present health.2 There are three areas are of particular importance: adding to the evidence base about the prevention, recognition and management of mental illness and co-morbid physical conditions service configuration, including practice based commissioning, access to services, user involvement and whole system interactions between primary, voluntary and secondary services and patients improving quality of care, including implementing evidence-based interventions, training of primary care professionals and influencing policy. Many areas of mental health delivery have been well researched and our emphasis may need to move from generating new data to implementation and quality improvement. For example, over the past decade, trials based in primary care have shown the effectiveness of collaborative care models in treating depression.3 This could be an area where implementation and dissemination by means of audit, training and strategy changes may take precedence over generating new evidence. There are, however, numerous fields lacking a firm evidence base and here the emphasis may need to remain with generating new knowledge. For example, the primary care management of paediatric psychiatric disorders is significantly under researched. The situation is compounded by relatively poor incentives for general practitioners to institute comprehensive child health programmes, leading to service fragmentation and inadequate resource allocation.4 The analysis of the strengths of London primary care in relation to its needs may provide a focus for the editorial strategy. London has a wealth of academic resources yet there are significant problems with translating evidence generated in specialist psychiatric settings to primary care.5 London has a highly developed network of health services yet there are significant problems with voluntary-primary-secondary services co-operation.6 London has a growing, multicultural and very diverse population. This diverse population faces significant inequalities in the services access and outcomes, but there is also growing evidence of effective tackling 7,8 London, therefore, provides a unique environment for advancing the knowledge of mental health care in primary care. In turn, this experience is likely to be of interest not only across the UK, but also to the international audience of large city primary care providers that may well share similar challenges. The issue of mental health policy is of special interest as it is argued that a major change is urgently needed. Mental health care is significantly under-resourced in virtually every country of the world. Psychiatric illnesses contribute 12% to the global burden of disease, whereas even industrialised nations spend on average about 5% of their health budget on mental health care.9 This is further complicated by trying to balance prevention and treatment programmes. Most countries do not spend sufficient money to afford both with clear preference to the latter in most cases. A further consideration is the role of audit. On the one hand, the NHS spends at least £220m on audits,10 that frequently remain incomplete11 and may not lead to any clinical care changes at all. On the other hand, audit is undoubtedly one of the most effective tools of progress in medicine.11 A metropolitan primary care journal is likely to be in a strong position to disseminate evidence on the economic effectiveness and feasibility of mental health interventions in primary care that may well help inform the policy decision making process. In conclusion, we have the potential to become a novel and influential voice in the diverse field of the delivery of mental health services in large urban areas around the world. We will focus specifically on the problems and achievements of metropolitan primary care, especially London, to generate evidence, disseminate best practice and provide a platform for policy change.