Pathways to Recovery: A case for adoption of systematic pathways in psychosis

Imperial College Health Partners, September 2015

This joint briefing paper published with Wessex AHSN, sets out how ICHP have developed new, integrated care pathways for mental health that prescribe time frames around clinical interventions and service delivery.  These new psychosis pathways aim to reduce the impact of disease and promote recovery by ensuring that every individual gets the best evidence based care at the right time and in the right place. The approach has used a robust methodology which can be adopted for use across the wider NHS. This document describes the approach used in developing the pathways and provides a guide for patients, carers, provider organisations and commissioners on adoption and implementation.

Click here for further information and to download the briefing paper.

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Viewpoint: reconsidering accountability in an age of integrated care

Nuffield Trust, July 2015

This paper examines the future of governance and accountability in the NHS and social care amid the rise of new provider models, a growing focus on integration and deep cuts in council funding.

Click here to download the full report.

Safe havens in Surrey

Centre of Excellence and Information Sharing, May 2015

This case study outlines how the co-location of professionals and a shared approach to service user care has enabled statutory and independent professionals to develop an understanding of each other’s roles and build confidence to share information to support people across Surrey in mental health crisis.

Click here to read the full text.

My life, my support, my choice: A narrative for person centred coordinated care & support for children & young people with complex lives

National Voices, March 2015

This report, published today by National Voices and the Think Local Act Personal partnership (TLAP), sets out how good, coordinated – or integrated – support looks to children and young people.  The report offers a clear set of outcomes that commissioners and service providers should be working to.  It covers children and young people up to the age of 25 and takes account of the transition into adulthood.

Click here for further information and to download the report.

Population health systems: going beyond integrated care

King’s Fund, February 2015

Integrated care has become a key focus of health service reform in England in recent years, as a response to fragmentation within the NHS and social care system. Yet efforts to integrate care services have rarely extended into a concern for the broader health of local populations and the impact of the wider determinants of health. This is a missed opportunity. This paper from the King’s Fund aims to challenge those involved in integrated care and public health to ‘join up the dots’, seeing integrated care as part of a broader shift away from fragmentation towards an approach focused on improving population health.

Click here to view the full report.

Integrated primary care for patients with mental and physical multimorbidity: cluster randomised controlled trial of collaborative care for patients with depression comorbid with diabetes or cardiovascular disease

BMJ, 16 February 2015

The objective of this study was to test the effectiveness of an integrated collaborative care model for people with depression and long term physical conditions.

The design of the study was a  cluster randomised controlled trial in 36 general practices in the north west of England.

 Collaborative care included patient preference for behavioural activation, cognitive restructuring, graded exposure, and/or lifestyle advice, management of drug treatment, and prevention of relapse. Up to eight sessions of psychological treatment were delivered by specially trained psychological wellbeing practitioners employed by Improving Access to Psychological Therapy services in the English National Health Service; integration of care was enhanced by two treatment sessions delivered jointly with the practice nurse. Usual care was standard clinical practice provided by general practitioners and practice nurses.

19 general practices were randomised to collaborative care and 20 to usual care; three practices withdrew from the trial before patients were recruited. 191 patients were recruited from practices allocated to collaborative care, and 196 from practices allocated to usual care. After adjustment for baseline depression score, mean depressive scores were 0.23 SCL-D13 points lower (95% confidence interval −0.41 to −0.05) in the collaborative care arm, equal to an adjusted standardised effect size of 0.30. Patients in the intervention arm also reported being better self managers, rated their care as more patient centred, and were more satisfied with their care. There were no significant differences between groups in quality of life, disease specific quality of life, self efficacy, disability, and social support.

The study concludes that collaborative care that incorporates brief low intensity psychological therapy delivered in partnership with practice nurses in primary care can reduce depression and improve self management of chronic disease in people with mental and physical multimorbidity. The size of the treatment effects were modest and were less than the prespecified effect but were achieved in a trial run in routine settings with a deprived population with high levels of mental and physical multimorbidity.

Click here to read the full text article.