Nieuwe functie in eerstelijn; primary care mental health worker. Overzicht van verschillende studies

Bower P. Primary care mental health workers: models of working and evidence of effectiveness. Br J Gen Pract 2002 Nov;52(484):926-33

Het NHS Plan stelt de creatie van een nieuwe rol in de eerste lijn voor om te helpen bij het beheer van de vaak voorkomende geestelijke gezondheidsproblemen: de primaire geestelijke gezondheidzorg medewerker. Het is echter niet duidelijk hoe zij moeten worden ingezet om het meest effectief te zijn. Actuele literatuur over verschillende modellen van de geestelijke gezondheidszorg wordt herzien.

The NHS Plan proposed the creation of a new role in primary care to assist with the management of common mental health problems: the primary care mental health worker (PCMHW). However, it is not clear how PCMHWs should be employed to be most effective. Current literature concerning different models of mental health care is reviewed. This suggests that four key dimensions are of relevance: the types of patients that PCMHWs will manage; the degree to which PCMHWs will work autonomously, or as part of a system of care; at what stage in patients' illness trajectory they will intervene; and whether the role of PCMHWs will be related to clinical interventions, or whether they will have a wider, non-clinical role in the organisation and monitoring of care. Finally, published data concerning relevant interventions are presented. Experimental studies reporting the empirical outcomes associated with these models are reviewed in relation to four different outcomes: clinical effectiveness, cost effectiveness, patient satisfaction, and access to care. The data suggest that problem-solving therapy, group psycho-education, self-help, and some models of 'collaborative care' may be highly relevant to PCMHWs. Each model provides different advantages and disadvantages in terms of the four dimensions of outcome

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