Shared Care

The challenge of an effective comprehensive care in the Brazilian National Health System sustains a debate about the mMatrix support (MS) for the Family Health Strategy (FHS) while stressing the need for further studies on the subject. This paper aims to critically analyze the matrix support with the aid of scientific papers and documents from the Brazilian Ministry of Health, especially those directed to mental health (MH) matrix support in primary care. The results emphasize the importance of coordination between the MH and primary care, though they also indicate that MS in MH is encompassed within a health care model that is still under construction and that new theoretical-practical contributions and evaluative studies are needed for its improvement.

This Canadian Association of Social Psychiatry (CASP) Symposium highlights the Congress theme, showcasing Canadian social psychiatric innovations. The presentations span Canada’s two largest provinces, Ontario and Quebec, addressing: complementary urban and rural, and community- and hospital-based practices; contrasting in-person versus telemedicine clinical care and teaching; and general psychiatric consultations with specialized interventions from shared care in child psychiatry to early intervention in psychosis. Across diverse practice contexts, we discuss disparities in the health and mental health care of marginalized populations, identifying an emerging consensus of intersectional health concerns and disparities, taking into account populational/patient parameters and practice settings for social reconciliation.

Vincenzo Di Nicola: “Beyond Shared Care in Child Psychiatry: Collaborative Care and Community Consultations” – Based in the multicultural context of Montreal, this presentation reviews shared care and collaborative models which privilege consultations between primary and specialty care in children’s mental health, with a Quebec innovation called “Medical Specialists Responding in Child Psychiatry” for community mental health teams.

Manon Charbonneau: “Challenges in Rural Practice in the Côte-Nord Region of Eastern Quebec” – Based in Sept-Îles, Quebec, this presentation reviews the population and practice parameters of rural practice, which includes the indigenous Innuit people, highlighting the innovative use of telemedicine in both clinical care and teaching.

Constantin Tranulis: “Early Intervention in Psychosis: Where Neurobiology Meets Innovative Social Tools and Expands Psychiatric Frontiers” – Working in a Montreal university psychiatric institute, this clinician-researcher reviews the 25-year-old model of early intervention and its impact on the field, with both positive and negative consequences.

Sonu Gaind: “Mental Health Care of Marginalized Populations: How Do We Move from Disparity to Equity?” – In Toronto, Canada’s largest and most diverse city, where populational  characteristics and social factors intersect and accumulate to create health and mental disparities, this presentation explores root causes and how health care can move towards equity. 

Keywords: Shared care, community consultations, rural practice, early intervention, health disparities/equities

Background: Patients may decide to undertake shared care with a general practitioner (GP) during follow-up after treatment for localised melanoma. Routine imaging tests for surveillance may be commonly used despite no evidence of clinical utility. This study describes the frequency of shared care and routine tests during follow-up after treatment for localised melanoma.
Methods: We randomly sampled 351 people with localised melanoma [American Joint Cancer Committee (AJCC) substages 0 - II] who had not had recurrent or new primary melanoma diagnosed from a total of 902 people diagnosed and treated for localised melanoma at a specialist centre in 2014. We interviewed participants by telephone about their experience of follow-up in the past year, and documented the proportion of patients who
were undertaking shared care follow-up with a GP. We also recorded the frequency and type of investigations
during follow-up. We calculated weighted estimates that are representative of the full inception cohort.
Results: Of the 351 people who were invited to participate, 230 (66%) people consented to the telephone
interview. The majority undertook shared care follow-up with a GP (61%). People who choose to have shared care follow-up with a GP are more likely to be male (p = 0.006), have lower AJCC stage (p for trend = 0.02), reside in more remote areas (p for trend< 0.001), and are less likely to have completed secondary school (p < 0.001). Few people saw a non-doctor health practitioner as part of their follow-up (9%). Many people report undergoing tests for melanoma, much of which may be routine tests for surveillance (37%).
Conclusions: The majority of people treated for a first primary localised melanoma at a specialist centre, without
recurrent or new melanoma, choose to undertake shared care follow-up with a GP. Many appear to have routine
diagnostic imaging as part of their melanoma surveillance.
Keywords: Melanoma, Follow-up studies, Diagnostic imaging, Practice patterns, general practitioners,
Interdisciplinary communication, Surveys and questionnaires

AimShared care agreements, commissioned by local clinical commissioning groups, are formal agreements that set out prescribing arrangements to provide a safe and cost-effective service that covers the prescribing requirements and to allow for the continued involvement of a hospital consultant alongside the provision of care in primary care settings.1–3 However, primary care prescribers have often expressed hesitancy to accept responsibility for prescribing in paediatrics, leaving secondary and tertiary care providers to prescribe these medications instead,1 resulting in inappropriate pressures on hospital pharmacies and often leaves families with difficulties in securing ongoing supply. This study aimed to investigate the volume, cost and type of hospital outpatient paediatric prescribing associated with items for which prescribing responsibility could be transferred to primary care. As well as to identify whether the current shared care agreements; traffic light rating (TLR) system...

Objectives: The aim of this research was to investigate whether a training intervention to enhance collaboration between mental health and primary care professionals improved the detection and management of mental health problems in primary health care in four large cities in Brazil. The training intervention was a multifaceted program over 96 h focused on development of a shared care model.

Method: A quasiexperimental study design was undertaken with assessment of performance by nurse and general practitioners (GPs) pre- and postintervention. Rates of recognition of mental health disorders (compared with the General Health Questionnaire) were the primary outcome, while self-reports of patient-centered care, psychosocial interventions and referral were the secondary outcomes.

Results: Six to 8 months postintervention, no changes were observed in terms of rate of recognition across the entire sample. Nurses significantly increased their recognition rates (from 23% to 39%, P= .05), while GPs demonstrated a significant decrease (from 42% to 30%, P= .04). There were significant increases in reports of patient-centered care, but no changes in other secondary outcomes.

Conclusions: Training professionals in a shared care model was not associated with consistent improvements in the recognition or management of mental health problems. Although instabilities in the local context may have contributed to the lack of effects, wider changes in the system of care may be required to augment training and encourage reliable changes in behavior, and more specific educating models are necessary.

Maternal mental health problems affect up to 20% of women, with potentially deleterious effects to the mother and family. To address this serious problem, a Maternal Mental Health Program (MMHP) using a shared care approach was developed. A shared care approach can promote an efficient use of limited specialized maternal mental health services, strengthen collaboration between the maternal mental health care team and primary care physicians, increase access to maternal mental health care services, and promote primary care provider competence in treating maternal mental health problems. Aim The purpose of this research was to evaluate the impact of a MMHP using a shared care approach on maternal anxiety and depression symptoms of participants, the satisfaction of women and referring physicians, and whether the program met the intents of shared care approach (such as quick consultation, increased knowledge, and confidence of primary care physicians). We used a pre and post cross-secti...

Patients may decide to undertake shared care with a general practitioner (GP) during follow-up after treatment for localised melanoma. Routine imaging tests for surveillance may be commonly used despite no evidence of clinical utility. This study describes the frequency of shared care and routine tests during follow-up after treatment for localised melanoma. We randomly sampled 351 people with localised melanoma [American Joint Cancer Committee (AJCC) substages 0 - II] who had not had recurrent or new primary melanoma diagnosed from a total of 902 people diagnosed and treated for localised melanoma at a specialist centre in 2014. We interviewed participants by telephone about their experience of follow-up in the past year, and documented the proportion of patients who were undertaking shared care follow-up with a GP. We also recorded the frequency and type of investigations during follow-up. We calculated weighted estimates that are representative of the full inception cohort. Of th...

Présentation au 25e Colloque Scientifique Annuel de la Filiale du Québec et l'Est du Canada de l'American Psychiatric Association au thème de la "Santé mentale globale au 21e siècle" - Vendredi le 19 janvier 2018.

Presentation at the 25th Annual Scientific Meeting of the Quebec & Eastern Canada District Branch of the American Psychiatric Association - Friday, January 19th, 2018 on the subject of "21st Century Global Mental Health."

Background Maternal mental health problems affect up to 20% of women, with potentially deleterious effects to the mother and family. To address this serious problem, a Maternal Mental Health Program (MMHP) using a shared care approach was developed. A shared care approach can promote an efficient use of limited specialized maternal mental health services, strengthen collaboration between the maternal mental health care team and primary care physicians, increase access to maternal mental health care services, and promote primary care provider competence in treating maternal mental health problems.

Aim The purpose of this research was to evaluate the impact of a MMHP using a shared care approach on maternal anxiety and depression symptoms of participants, the satisfaction of women and referring physicians, and whether the program met the intents of shared care approach (such as quick consultation, increased knowledge, and confidence of primary care physicians).

Methods We used a pre and post cross-sectional study design to evaluate women’s depression and anxiety symptoms and the satisfaction of women and their primary care health provider with the program.

Findings Depression and anxiety symptoms significantly improved with involvement with the program. Women and physicians reported high levels of satisfaction with the program. Physician knowledge and confidence treating maternal mental health problems improved.

Conclusions Shared care can be an effective and efficient way to provide maternal mental health care in primary health care settings where resources are limited.