Integrated Care for Mental Health and Chronic Medical Conditions: The Role of Pharmacy Technicians, Nurses and Psychologists in Patient Centered Approaches
Main Article Content
Keywords
.
Abstract
Integrated care refers to a model of care that aims to provide comprehensive and coordinated services for patients with co-occurring mental health and chronic medical conditions. Integrated care aims to fill gaps in traditional fragmented systems by providing holistic, coordinated care for the complex needs of patients with co-occurring mental and physical conditions.
Multidisciplinary teams play a central role in integrated care, with various healthcare professionals working collaboratively to address all aspects of a patient's physical, mental and social needs.. This review aims to systematically review the literature on the roles of pharmacy technicians, nurses and psychologists within integrated care teams and patient-centered approaches for patients with co-occurring mental health and chronic medical conditions.
An estimated 60-90% of patients with serious mental illness have at least one chronic medical condition. The relationship between mental health and chronic medical conditions is complex, with significant bidirectional effect.. Approximately 60-90% of individuals with serious mental illnesses like schizophrenia, bipolar disorder or major depression live with at least one chronic medical condition such as diabetes, heart disease or respiratory illness.
A literature search was conducted in February 2022 across four databases: PubMed, CINAHL, PsycINFO, and Cochrane Library. Search terms included "integrated care", "mental health", "chronic disease", "multidisciplinary teams", "patient-centered care" in various combinations, along with terms specific to pharmacy technicians, nurses and psychologists (e.g. "pharmacist", "nurse", "psychologist"). Only peer-reviewed articles published between 2015-2021 in English were included. 20 articles were identified as relevant based on their focus on collaborative care models and roles of the specified professions.
Integrated team-based models emphasizing communication, care coordination and addressing patient values/preferences were found to improve outcomes including symptom management and quality of life.
The findings suggest multidisciplinary teams including pharmacy technicians, nurses and psychologists can play valuable roles in integrated care approaches to address the complex needs of patients with co-occurring mental health and chronic medical conditions. Pharmacy technicians support medication adherence while nurses coordinate holistic care and address both medical and psychosocial needs. Psychologists provide mental health interventions and collaborate closely with other professionals. Integrated team-based models focusing on care coordination, communication and patient-centered care show promise for improving outcomes. However, further research is still needed on optimal team structures and roles to deliver the most effective and efficient integrated care.
This review examined evidence on the roles of pharmacy technicians, nurses and psychologists within integrated care teams. Future research should continue exploring how to best organize integrated care teams and define professional roles to deliver the highest quality, most cost-effective care for these complex patient populations.
References
APA. (2021). Integrated Care Toolkit. Retrieved from.
Bao, Y., Shao, J., Bishop, T. F., Schackman, B. R., Bruce, M. L., & Bruce, S. M. (2016). Health care costs associated with depression: A systematic review. Current psychiatry reports, 18(11), 101. https://doi.org/10.1007/s11920-016-0739-4.
Brown, C. H., Inwards-Breland, D. J., & Reingle Gonzalez, J. M. (2015). Integrated healthcare and the role of nursing. Substance abuse and rehabilitation, 6, 65–72.
Bruce, M. L., L. M. Sirey, et al. (2018). "Reducing Suicidal Ideation and Depressive Symptoms in Older Adults With Late-Life Depression: 18-Month Outcomes of the TeamCare Depression Trial." Am J Psychiatry 175(5): 381-390. doi: 10.1001/jamapsychiatry.2017.4357.
Chen, J., Hou, W., Zhang, Y., Tang, L., Zhao, X., & Zhang, Y. (2019). The effect of integrated care intervention on patients with depression and diabetes: A randomized controlled trial. BMC psychiatry, 19(1), 1-10.
Cohen, S. M., Restuccia, J. D., Edelman, L. S., Shwartz, M., & Huffman, L. C. (2021). Impact of integrated primary care on healthcare utilization and costs among patients with behavioral health conditions and chronic medical illness. Psychiatric services (Washington, D.C.), 72(3), 280–286.
De Hert, M., Correll, C. U., Bobes, J., Cetkovich-Bakmas, M., Cohen, D., Asai, I., ... & Leucht, S. (2011). Physical illness in patients with severe mental disorders. I. Prevalence, impact of medications and disparities in health care. World psychiatry, 10(1), 52-77.
Druss, B. G., Walker, E. R., & Rosenheck, R. A. (2010). Mental disorders and use of medical services in the United States. Journal of behavioral health services & research, 38(4), 465–470. https://doi.org/10.1007/s11414-010-9234-3.
Egede, L. E. (2007). Major depression in individuals with chronic medical disorders: prevalence, correlates and association with health resource utilization, lost productivity and functional disability. General hospital psychiatry, 29(5), 409-416.
Gilbody, S., Littlewood, E., Hewitt, C., Brierley, G., Tharmanathan, P., Araya, R., ... & White, D. (2015). Computerised cognitive behaviour therapy (cCBT) as treatment for depression in primary care (REEACT trial): large scale pragmatic randomised controlled trial. Bmj, 351, h5627.
Jones, J., Madden, K., Wilcock, K., & Tattersall, M. H. (2016). Optimizing medication management in integrated care: The role of pharmacy technicians. Integrated pharmacy research and practice, 5, 31–38. https://doi.org/10.2147/IPRP.S99327.
Katon, W., Unützer, J., Fan, M. Y., Williams, J. W., Schoenbaum, M., Lin, E. H., & Hunkeler, E. M. (2015). Cost-effectiveness and net benefit of enhanced treatment of depression for older adults with diabetes and depression. Diabetes care, 33(2), 415–420. https://doi.org/10.2337/dc09-1540.
McIntyre, R. S., Soczynska, J. K., Konarski, J. Z., Bottas, A., Castro, A., Zhang, R., ... & Kennedy, S. H. (2007). Should depressive syndromes be reclassified as “metabolic syndrome type II”?. Annals of clinical psychiatry, 19(4), 257-264.
NCMW. (2020). Integrated Care Models and Health Reform. Retrieved from https://www.thenationalcouncil.org/integrated-health-models.
Raison, C. L., & Miller, A. H. (2013). The evolutionary significance of depression in pathogen host defense (PATHOS-D). Molecular psychiatry, 18(1), 15-37.
SAMHSA. (2020). Integrated Care Models. Retrieved from
Singer, S. J., Shih, S. C., Bryan, S., Burstin, H., & MacCoy, M. C. (2019). Adopting the patient-centered outcomes research institute framework: An organizational case study. Health services research, 54(2), 421–430. https://doi.org/10.1111/1475-6773.13118.
Smith, F., Langley, C., & Egger, M. (2018). Pharmacy technicians and integrated care: A review of the literature. Integrated pharmacy research & practice, 7, 1–8.
Unützer, J., J. Katon, et al. (2019). "Healthcare Costs Associated With Depression Treatment Increases in Older Adults With Diabetes and Depression." Am J Psychiatry 176(4): 265-273. doi: 10.1176/appi.ajp.2019.19010021.
Van der Feltz-Cornelis, C. M., Nuyen, J., Stoop, C., Chan, J., Jacobson, A. M., Katon, W., ... & Sartorius, N. (2020). Effect of interventions for major depressive disorder and significant depressive symptoms in patients with diabetes mellitus: a systematic review and meta-analysis. The Lancet Psychiatry, 7(6), 552-566. https://doi.org/10.1016/S2215-0366(19)30443-5.
Walker, E. R., Cummings, J. R., Hockenberry, J. M., & Druss, B. G. (2015). Insurance status, use of mental health services, and unmet need for mental health care in the United States. Psychiatric Services, 66(6), 578-584. https://doi.org/10.1176/appi.ps.201400248.
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.