Background: A care manager organization, based on a collaborative care model, was implemented in the primary health care service in Region Västra Götaland, Sweden, to improve the care of persons with common mental disorders (CMDs). We aimed to investigate the association between the care manager organization and number of health care contacts, and the extent of psychotherapy among female and male patients with CMD compared to primary health care centers (PHCCs) offering usual care, in the introductory year of implementation with one year follow-up.
Methods: This register-based study included all PHCCs in the region, which were analyzed in two groups depending on their care manager status. The study periods were 2015.09.01– 2016.08.31 (first year) and 2016.09.01– 2017.08.31 (second year). Data on health care contacts and psychotherapy per PHCC were obtained from a health care register. The mean number and proportion of visits to different health care professionals, and the proportion of patients with short-term versus long-term psychotherapy were measured. A linear mixed-effects model for cross-sectional and longitudinal analysis was implemented as well as a generalized linear regression model for possible interaction effects of PHCC characteristic on care manager status and outcomes.
Results: PHCCs with a care manager organization had more nurse contacts (p = 0.001 for both year 1 and year 2) compared to PHCCs with usual care. PHCCs with usual care had a significantly lower proportion of visits to psychotherapists and a higher proportion of both female and male patients receiving short-term psychotherapy (1– 5 sessions vs ≥ 6) over time and compared to PHCCs with a care manager organization.
Conclusion: With a care manager organization, nurse contacts increased at the PHCCs. However, this did not negatively influence the visits to a general practitioner and to psychotherapists. This evaluation showed that the care manager organization at PHCC level implies higher accessibility and sustainability of care for up to two years after implementation.



中文翻译：

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护理经理组织的实施及其与医疗保健联系人和心理治疗的关联：瑞典初级保健中心的基于登记册的真实生活结果研究

背景：在瑞典西哥德兰地区的初级卫生保健服务中实施了一个基于协作护理模式的护理经理组织，以改善对常见精神障碍 (CMD) 患者的护理。我们旨在调查护理经理组织与医疗保健联系人数量之间的关联，以及与提供常规护理的初级卫生保健中心 (PHCC) 相比，女性和男性 CMD 患者的心理治疗程度一年随访。
方法：这项基于登记的研究包括该地区的所有 PHCC，根据他们的护理经理身份分为两组进行分析。研究时间为 2015.09.01-2016.08.31（第一年）和 2016.09.01-2017.08.31（第二年）。每个 PHCC 的医疗保健接触和心理治疗的数据来自医疗保健登记册。测量了访问不同医疗保健专业人员的平均次数和比例，以及接受短期与长期心理治疗的患者比例。实施了用于横断面和纵向分析的线性混合效应模型以及用于 PHCC 特征对护理经理状态和结果的可能交互影响的广义线性回归模型。
结果：与具有常规护理的 PHCC 相比，具有护理管理机构的 PHCC 有更多的护士联系（第 1 年和第 2 年 p = 0.001）。与具有护理管理机构的 PHCC 相比，具有常规护理的 PHCC 的心理治疗师就诊比例显着降低，而接受短期心理治疗的女性和男性患者比例较高（1-5 次对 ≥ 6 次）。
结论：通过护理经理组织，PHCC 的护士接触增加。然而，这并没有对全科医生和心理治疗师的访问产生负面影响。该评估表明，PHCC 级别的护理经理组织意味着在实施后长达两年的护理可及性和可持续性更高。