Clinical Nurse SpecialistA Copyright B 2015 Wolters Kluwer Health, Inc. All rights reserved.
Cochrane Nursing Care Corner Column Editor: Susan B. Fowler, PhD, RN, CNRN, FAHA
Collaborative Care Approaches for People With Severe Mental Illness Christine Neville, PhD, RN, FACMHN
KEYWORDS: collaborative care, collaborative care approaches, community mental healthcare, severe mental illness
REVIEW QUESTION What is the effectiveness of collaborative care approaches for people with severe mental illness living in the community? NURSING IMPLICATIONS The aim of collaborative care is to improve the mental and physical healthcare of people with severe mental illness. It involves health workers in the primary care sector such as medical practitioners, nurses, social workers, and psychologists communicating closely and working together. This ensures the total healthcare experience for a person with severe mental illness is streamlined, comprehensive, and less confusing. The mobility of nurses and the comprehensive scope of their practice make them an integral part of the collaborative care model. STUDY CHARACTERISTICS One randomized controlled trial with 330 participants older than 18 years investigated the benefits of collaborative care compared with standard care.1 Standard care was defined as a community or outpatient model of care not described as collaborative care. This study was conducted in the United States with veterans who had a diagnosis of bipolar disorder. Although other types of severe mental illness were considered, no other trials met the inclusion criteria. With 1 study for review, reanalysis of the data occurred rather than meta-analysis. The primary outcome of interest Author Affiliation: Associate Professor, School of Nursing and Midwifery, University of Queensland Brisbane, Queensland, Australia. Dr Neville is a member of the Cochrane Nursing Care Field (CNCF). The author reports no conflicts of interest. Correspondence: Susan B. Fowler, PhD, RN, CNRN, FAHA, Walden University, 165 Essex Ave, Unit 106, Metuchen, NJ08840 ([email protected]). DOI: 10.1097/NUR.0000000000000127
Clinical Nurse Specialist
was psychiatric admission. Secondary outcome measures included mental state, physical health status, compliance with medication, social functioning, alcohol and drug use, death, quality of life, cost of treatment, satisfaction (participant, carer, and staff), and attrition. The duration of the intervention was 3 years. SUMMARY OF KEY EVIDENCE Participants were allocated to the intervention group (n = 167) and to usual care (n = 163). Twenty-four participants left the study after randomization. The mean age of the sample was 46.6 (SD, 10.1) years, 9% were female, and 23.3% were from ethnic minority groups. It was determined that the study was of low- or very low-quality evidence. The risk of bias for the study overall was judged to be ‘‘high.’’ There was adequate randomization, but other limitations noted were unreported allocation concealment, incomplete outcome data, and selective reporting with no reported blinding of outcome assessors or participants and personnel. Results indicated that for year 2 of the study, collaborative care significantly reduced psychiatric admissions when compared with standard care (n = 306; relative risk [RR], 0.75; 95% confidence interval [CI], 0.57Y0.99). In addition, at the 3-year follow-up, it was found that collaborative care significantly improved the mental health component of quality of life (n = 306; mean deviation [MD], 3.50; 95% CI, 1.80Y5.20) but not the physical health component of quality of life (n = 306; MD, 0.50; 95% CI, j0.91 to 1.91). In relation to costeffectiveness, it was found that the direct intervention costs of collaborative care did not significantly differ from standard care (n = 306; MD, $2981.00; 95% CI, j$16 934.93 to $10 972.93). There was no significant difference between the groups for the proportion of participants that exited the study early (n = 306; MD, 1.71; 95% CI, 0.77Y3.97), death by suicide (n = 330; RR, 0.34; 95% CI, 0.01Y8.32), or death by natural causes (n = 330; RR, 1.54; 95% CI, 0.65Y3.66). The reasons for attrition were not reported. Although positive effects were
A
www.cns-journal.com
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
143
Cochrane Nursing Care Corner noted for other secondary outcomes of mental state, social functioning, compliance with medication, and treatment satisfaction, incomplete data prevented a full report of these in the review. There was no report for alcohol and drug use. BEST PRACTICE RECOMMENDATIONS Based on 1 study, there is insufficient evidence to make any reliable or generalizable conclusions that collaborative care approaches are effective for people with severe mental illness. However, the study did find that psychiatric admissions were
144
reduced and noted improvements in mental health status and quality of life. Therefore, collaborative care may be useful for people with severe mental illness, but trials that are more thoroughly designed, conducted, and reported are needed to support more definitive recommendations. Reference 1. Reilly S, Planner C, Gask L, et al. Collaborative care approaches for people with severe mental illness. Cochrane Database Syst Rev 2013;(11):Art. no.: CD009531.
www.cns-journal.com
May/June 2015
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
Cochrane Nursing Care Corner Column Editor: Susan B. Fowler, PhD, RN, CNRN, FAHA
Collaborative Care Approaches for People With Severe Mental Illness Christine Neville, PhD, RN, FACMHN
KEYWORDS: collaborative care, collaborative care approaches, community mental healthcare, severe mental illness
REVIEW QUESTION What is the effectiveness of collaborative care approaches for people with severe mental illness living in the community? NURSING IMPLICATIONS The aim of collaborative care is to improve the mental and physical healthcare of people with severe mental illness. It involves health workers in the primary care sector such as medical practitioners, nurses, social workers, and psychologists communicating closely and working together. This ensures the total healthcare experience for a person with severe mental illness is streamlined, comprehensive, and less confusing. The mobility of nurses and the comprehensive scope of their practice make them an integral part of the collaborative care model. STUDY CHARACTERISTICS One randomized controlled trial with 330 participants older than 18 years investigated the benefits of collaborative care compared with standard care.1 Standard care was defined as a community or outpatient model of care not described as collaborative care. This study was conducted in the United States with veterans who had a diagnosis of bipolar disorder. Although other types of severe mental illness were considered, no other trials met the inclusion criteria. With 1 study for review, reanalysis of the data occurred rather than meta-analysis. The primary outcome of interest Author Affiliation: Associate Professor, School of Nursing and Midwifery, University of Queensland Brisbane, Queensland, Australia. Dr Neville is a member of the Cochrane Nursing Care Field (CNCF). The author reports no conflicts of interest. Correspondence: Susan B. Fowler, PhD, RN, CNRN, FAHA, Walden University, 165 Essex Ave, Unit 106, Metuchen, NJ08840 ([email protected]). DOI: 10.1097/NUR.0000000000000127
Clinical Nurse Specialist
was psychiatric admission. Secondary outcome measures included mental state, physical health status, compliance with medication, social functioning, alcohol and drug use, death, quality of life, cost of treatment, satisfaction (participant, carer, and staff), and attrition. The duration of the intervention was 3 years. SUMMARY OF KEY EVIDENCE Participants were allocated to the intervention group (n = 167) and to usual care (n = 163). Twenty-four participants left the study after randomization. The mean age of the sample was 46.6 (SD, 10.1) years, 9% were female, and 23.3% were from ethnic minority groups. It was determined that the study was of low- or very low-quality evidence. The risk of bias for the study overall was judged to be ‘‘high.’’ There was adequate randomization, but other limitations noted were unreported allocation concealment, incomplete outcome data, and selective reporting with no reported blinding of outcome assessors or participants and personnel. Results indicated that for year 2 of the study, collaborative care significantly reduced psychiatric admissions when compared with standard care (n = 306; relative risk [RR], 0.75; 95% confidence interval [CI], 0.57Y0.99). In addition, at the 3-year follow-up, it was found that collaborative care significantly improved the mental health component of quality of life (n = 306; mean deviation [MD], 3.50; 95% CI, 1.80Y5.20) but not the physical health component of quality of life (n = 306; MD, 0.50; 95% CI, j0.91 to 1.91). In relation to costeffectiveness, it was found that the direct intervention costs of collaborative care did not significantly differ from standard care (n = 306; MD, $2981.00; 95% CI, j$16 934.93 to $10 972.93). There was no significant difference between the groups for the proportion of participants that exited the study early (n = 306; MD, 1.71; 95% CI, 0.77Y3.97), death by suicide (n = 330; RR, 0.34; 95% CI, 0.01Y8.32), or death by natural causes (n = 330; RR, 1.54; 95% CI, 0.65Y3.66). The reasons for attrition were not reported. Although positive effects were
A
www.cns-journal.com
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
143
Cochrane Nursing Care Corner noted for other secondary outcomes of mental state, social functioning, compliance with medication, and treatment satisfaction, incomplete data prevented a full report of these in the review. There was no report for alcohol and drug use. BEST PRACTICE RECOMMENDATIONS Based on 1 study, there is insufficient evidence to make any reliable or generalizable conclusions that collaborative care approaches are effective for people with severe mental illness. However, the study did find that psychiatric admissions were
144
reduced and noted improvements in mental health status and quality of life. Therefore, collaborative care may be useful for people with severe mental illness, but trials that are more thoroughly designed, conducted, and reported are needed to support more definitive recommendations. Reference 1. Reilly S, Planner C, Gask L, et al. Collaborative care approaches for people with severe mental illness. Cochrane Database Syst Rev 2013;(11):Art. no.: CD009531.
www.cns-journal.com
May/June 2015
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
