Organizational models of the mental health service in primary health care: An Evidence Map

Session Type
Oral presentation
Synthesis of evidence without meta-analysis
Kühn-Barrientos L1, Vargas-Malebrán N1, Palominos-Veas C1
1Ministry of Health, Chile

Background: The Chilean Ministry of Health is redesigning the mental healthcare strategy in primary health care (PHC) with an integral perspective based on community and continuity of care. An evidence-informed decision-making approach was followed to inform policymakers on the characteristics of organizational models of mental healthcare at the PHC.
Objectives: To elaborate an evidence gap map that identifies organizational models of mental healthcare at the PHC.
Methods: A search strategy was performed on three databases: PUBMED, EMBASE and Epistemonikos. Systematics Reviews (SR) with effectiveness evaluation of mental health models in PHC in patients with mental diseases were included. Selection and data extraction were performed by 2 authors independently.
Results: Out of 1759 articles we mapped and characterized 60 SR, categorizing the evidence in five mental healthcare models framed in integrated care models: Collaborative or Share Care Model (CCM), Stepped Care (SCM), Replacement or Referral, Training primary care staff and Consultant-Liaison. The main differences were the level of integration and the healthcare professionals engaged. The CCM was the most analysed, being included in 95% of the SRs (n=57), while the SCM was the least (n=11). These models addressed mainly depression (n=48) and only 1 SR studied suicide and personality disorders. The effectiveness was measured in outcomes like clinic management as well as treatment adherence, response and acceptability. The adult and older adult populations were the most studied. North America and Europe lead the number of studies (n=59 and 56, respectively), whereas Latin America and the Caribbean have limited evidence (n=8).
Conclusions: This EGM classifies and characterizes the wide diversity of care models into specific categories. The map facilitates the visualization of the magnitude of the evidence, the information gaps and allows to understand the outcomes used to measure effectiveness. It provides a framework for future research to fill the evidence gaps and helps policymakers understand which model better apply in their PHC context.