Is the Norwegian stepped care model for allocation of patients with mental health problems working as intended? A cross-sectional study.

IF 2.6 1区心理学 Q2 PSYCHOLOGY, CLINICAL Psychotherapy Research Pub Date : 2024-07-22 DOI:10.1080/10503307.2024.2378017

Martin Schevik Lindberg, Martin Brattmyr, Jakob Lundqvist, Stian Solem, Odin Hjemdal, Eirik Roos, Ane Bjøru Fjeldsæter, Thröstur Björgvinsson, Peter Cornish, Audun Havnen

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Abstract

Objective: Stepped care models are frameworks for mental health care systems in several countries. According to Norwegian guidelines, individuals with mental health problems of mild severity should be treated in community mental health services, moderate severity in specialist mental health services, while complex/severe problems are often a shared responsibility. This study investigated whether patients are allocated as intended.

Methods: In a cross-sectional study, 4061 outpatients recruited from community- and specialist mental health services reported demographic variables, symptoms of anxiety/depression, functional impairment, health status, and sick leave status. The community sample consisted of two subsamples: mild/moderate problems and complex problems.

Results: There was substantial overlap (80%-99%) of symptoms, impairment, and health between community- and specialist mental health services. More impairment, worse health, lower age, and being male were associated with treatment at specialist level compared to community mild/moderate. Better health, being in a relationship, and lower age were associated with specialized treatment compared to community complex group.

Conclusion: The limited association between treatment level and symptoms and functional impairment reveals inconsistencies between treatment guidelines and clinical practice. How the existing organization affects patient outcomes and satisfaction should be investigated further.

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挪威为精神疾病患者提供的阶梯式护理模式是否达到预期效果？一项横断面研究。

目的：阶梯式护理模式是一些国家精神健康护理系统的框架。根据挪威的指导方针，有轻度精神健康问题的人应在社区精神健康服务机构接受治疗，有中度精神健康问题的人应在专科精神健康服务机构接受治疗，而有复杂/严重问题的人通常需要共同承担责任。本研究调查了患者是否按计划分配：在一项横断面研究中，从社区和专科精神卫生服务机构招募的 4061 名门诊患者报告了人口统计学变量、焦虑/抑郁症状、功能障碍、健康状况和病假情况。社区样本包括两个子样本：轻度/中度问题和复杂问题：结果：社区和专科心理健康服务在症状、功能障碍和健康状况方面存在大量重叠（80%-99%）。与社区轻度/中度问题相比，更多的损伤、更差的健康状况、更低的年龄和男性与专科治疗有关。与社区综合组相比，健康状况较好、有伴侣和年龄较低的人与专科治疗有关：治疗水平与症状和功能障碍之间的关联有限，这表明治疗指南与临床实践之间存在不一致。现有机构如何影响患者的治疗效果和满意度，还需进一步研究。

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来源期刊

Psychotherapy Research PSYCHOLOGY, CLINICAL-

CiteScore

7.80

自引率

10.30%

发文量

期刊介绍： Psychotherapy Research seeks to enhance the development, scientific quality, and social relevance of psychotherapy research and to foster the use of research findings in practice, education, and policy formulation. The Journal publishes reports of original research on all aspects of psychotherapy, including its outcomes, its processes, education of practitioners, and delivery of services. It also publishes methodological, theoretical, and review articles of direct relevance to psychotherapy research. The Journal is addressed to an international, interdisciplinary audience and welcomes submissions dealing with diverse theoretical orientations, treatment modalities.