Liquidity and uncertainty: digital adaptation of a complex intervention for people with severe mental illness during the COVID-19 lockdown

This is the final version. Available on open access from BMC via the DOI in this recordAvailability of data and materials: Transcripts will not be shared in their entirety to protect the anonymity of participants and the facilitators delivering the intervention. However, requests for excerpts of the data will be considered on an individual basis. Please contact the corresponding author.Background This paper explores the extent to which the implementation and evaluation of a collaborative care model of face-to-face service delivery for people with severe mental illness was viable during the first UK lockdown associated with COVID-19. The PARTNERS2 cluster randomised controlled trial and process evaluation were co-designed with service users and carers. The aim of this paper is to explore whether digital adaptation of the PARTNERS model for people with severe mental illness during the COVID-19 lockdown was equitable, in terms of fostering collaboration and trust in a vulnerable population. Results We collected qualitative data from multiple sources during lockdown and subsequently constructed case-studies of participating secondary care workers. We adopted Bauman’s notions of liquid modernity to inform our analysis, and identified that digital adaptation during lockdown was only successful where organisational policies, care partner skills and service users’ existing resources were optimal. Conclusion PARTNERS2 can be delivered digitally by a care partner to support people with severe mental illness to identify and work towards their goals when existing resources are optimal. However, at a time of increased need, we identified that people who are very unwell and living with limited access to resources and opportunities, remained disenfranchised at great cost. Trial registration ISRCTN 95702682, registered 26.10.2017National Institute for Health and Care Research (NIHR

Evaluation of a primary care-based collaborative care model (PARTNERS2) for people with diagnoses of schizophrenia, bipolar, or other psychoses: study protocol for a cluster randomised controlled trial

YesCurrent NHS policy encourages an integrated approach to provision of mental and physical care for individuals with long term mental health problems. The 'PARTNERS2' complex intervention is designed to support individuals with psychosis in a primary care setting. The trial will evaluate the clinical and cost-effectiveness of the PARTNERS2 intervention. This is a cluster randomised controlled superiority trial comparing collaborative care (PARTNERS2) with usual care, with an internal pilot to assess feasibility. The setting will be primary care within four trial recruitment areas: Birmingham & Solihull, Cornwall, Plymouth, and Somerset. GP practices are randomised 1:1 to either (a) the PARTNERS2 intervention plus modified standard care ('intervention'); or (b) standard care only ('control'). PARTNERS2 is a flexible, general practice-based, person-centred, coaching-based intervention aimed at addressing mental health, physical health, and social care needs. Two hundred eligible individuals from 39 GP practices are taking part. They were recruited through identification from secondary and primary care databases. The primary hypothesis is quality of life (QOL). Secondary outcomes include: mental wellbeing, time use, recovery, and process of physical care. A process evaluation will assess fidelity of intervention delivery, test hypothesised mechanisms of action, and look for unintended consequences. An economic evaluation will estimate its cost-effectiveness. Intervention delivery and follow-up have been modified during the COVID-19 pandemic. The overarching aim is to establish the clinical and cost-effectiveness of the model for adults with a diagnosis of schizophrenia, bipolar, or other types of psychoses.PARTNERS2 is funded by the National Institute for Health Research (NIHR) under its Programme Grant for Applied Research Programme (grant number: RP-PG- 200625). This research was also supported by the NIHR Collaboration for Leadership in Applied Health Research and Care South West Peninsula at the Royal Devon and Exeter NHS Foundation Trust

Collaborative care approaches for people with severe mental illness

Background Collaborative care for severe mental illness (SMI) is a community‐based intervention that promotes interdisciplinary working across primary and secondary care. Collaborative care interventions aim to improve the physical and/or mental health care of individuals with SMI. This is an update of a 2013 Cochrane review, based on new searches of the literature, which includes an additional seven studies. Objectives To assess the effectiveness of collaborative care approaches in comparison with standard care (or other non‐collaborative care interventions) for people with diagnoses of SMI who are living in the community. Search methods We searched the Cochrane Schizophrenia Study‐Based Register of Trials (10 February 2021). We searched the Cochrane Common Mental Disorders (CCMD) controlled trials register (all available years to 6 June 2016). Subsequent searches on Ovid MEDLINE, Embase and PsycINFO together with the Cochrane Central Register of Controlled Trials (with an overlap) were run on 17 December 2021. Selection criteria Randomised controlled trials (RCTs) where interventions described as 'collaborative care' were compared with 'standard care' for adults (18+ years) living in the community with a diagnosis of SMI. SMI was defined as schizophrenia, other types of schizophrenia‐like psychosis or bipolar affective disorder. The primary outcomes of interest were: quality of life, mental state and psychiatric admissions at 12 months follow‐up. Data collection and analysis Pairs of authors independently extracted data. We assessed the quality and certainty of the evidence using RoB 2 (for the primary outcomes) and GRADE. We compared treatment effects between collaborative care and standard care. We divided outcomes into short‐term (up to six months), medium‐term (seven to 12 months) and long‐term (over 12 months). For dichotomous data we calculated the risk ratio (RR) and for continuous data we calculated the standardised mean difference (SMD), with 95% confidence intervals (CIs). We used random‐effects meta‐analyses due to substantial levels of heterogeneity across trials. We created a summary of findings table using GRADEpro. Main results Eight RCTs (1165 participants) are included in this review. Two met the criteria for type A collaborative care (intervention comprised of the four core components). The remaining six met the criteria for type B (described as collaborative care by the trialists, but not comprised of the four core components). The composition and purpose of the interventions varied across studies. For most outcomes there was low‐ or very low‐certainty evidence. We found three studies that assessed the quality of life of participants at 12 months. Quality of life was measured using the SF‐12 and the WHOQOL‐BREF and the mean endpoint mental health component scores were reported at 12 months. Very low‐certainty evidence did not show a difference in quality of life (mental health domain) between collaborative care and standard care in the medium term (at 12 months) (SMD 0.03, 95% CI ‐0.26 to 0.32; 3 RCTs, 227 participants). Very low‐certainty evidence did not show a difference in quality of life (physical health domain) between collaborative care and standard care in the medium term (at 12 months) (SMD 0.08, 95% CI ‐0.18 to 0.33; 3 RCTs, 237 participants). Furthermore, in the medium term (at 12 months) low‐certainty evidence did not show a difference between collaborative care and standard care in mental state (binary) (RR 0.99, 95% CI 0.77 to 1.28; 1 RCT, 253 participants) or in the risk of being admitted to a psychiatric hospital at 12 months (RR 5.15, 95% CI 0.67 to 39.57; 1 RCT, 253 participants). One study indicated an improvement in disability (proxy for social functioning) at 12 months in the collaborative care arm compared to usual care (RR 1.38, 95% CI 0.97 to 1.95; 1 RCT, 253 participants); we deemed this low‐certainty evidence. Personal recovery and satisfaction/experience of care outcomes were not reported in any of the included studies. The data from one study indicated that the collaborative care treatment was more expensive than standard care (mean difference (MD) international dollars (Int$) 493.00, 95% CI 345.41 to 640.59) in the short term. Another study found the collaborative care intervention to be slightly less expensive at three years. Authors' conclusions This review does not provide evidence to indicate that collaborative care is more effective than standard care in the medium term (at 12 months) in relation to our primary outcomes (quality of life, mental state and psychiatric admissions). The evidence would be improved by better reporting, higher‐quality RCTs and the assessment of underlying mechanisms of collaborative care. We advise caution in utilising the information in this review to assess the effectiveness of collaborative care

The effectiveness of a primary care based collaborative care model to improve quality of life in people with severe mental illness: the PARTNERS2 cluster randomised controlled trial

This is the author accepted manuscript.Data Availability and Governance Statement: Anonymised data may be made available by request to corresponding author. The study protocol has been published and a link to statistical analysis plan is included in the paper. CONSORT 2010 guidelines were followed in the reporting of this trial. Several authors had full access to all the data in the study and had final responsibility for the decision to submit for publication. Changes from the original funding proposal include, following pilot work, a funded extension for a full trial (rather than an external pilot trial as originally funded), which is described in the published protocol, trial registry and statistical analysis plan. The discrepancies from the published protocol included provision of top up training for existing practitioners during the trial, changes made in response to COVID-19 included online delivery and remote data collection. The study protocol and statistical analysis plan have been publishedBackground Individuals living with severe mental illness can have significant emotional, physical and social challenges. Collaborative Care combines clinical and organisational components. Aim We tested whether a primary care-based Collaborative Care model (PARTNERS) would improve quality of life for people with diagnoses of schizophrenia, bipolar disorder or other psychoses compared to usual care. Methods A general practice-based cluster randomised controlled superiority trial (ISRCTN 95702682). Practices were recruited from four English regions and allocated (1:1) to intervention or control. Individuals receiving limited input in secondary care or who were under primary care only were eligible. The 12-month PARTNERS intervention incorporated person centred coaching support and liaison work. The primary outcome was change in Manchester Short Assessment of Quality of Life (MANSA). Results We allocated 39 general practices, with 198 participants, to the PARTNERS intervention (20 practices; 116 participants) or control (19 practices; 82 participants). Primary outcome data were available for 99 (85.3%) intervention and 71 (86.6%) control participants. Mean change in overall MANSA score did not differ between the groups (0.25 (s.d. 0.73) for intervention vs 0.21 (s.d. 0.86) for control); estimated fully adjusted between group difference 0.03, 95% CI -0.25 to 0.31; p=0.819. Acute mental health episodes (safety outcome) included three crises among those receiving the intervention and four among those not. Conclusion There was no evidence of a difference in quality of life, as measured with the MANSA, between those receiving the PARTNERS intervention and usual care. Shifting care to primary care was not associated with increased adverse outcomesNational Institute for Health Research (NIHR

The effectiveness of a primary care based collaborative care model to improve quality of life in people with severe mental illness: the PARTNERS2 cluster randomised controlled trial

Background: Individuals living with severe mental illness can have significant emotional, physical and social challenges. Collaborative Care combines clinical and organisational components. Aim: We tested whether a primary care-based Collaborative Care model (PARTNERS) would improve quality of life for people with diagnoses of schizophrenia, bipolar disorder or other psychoses compared to usual care. Methods: A general practice-based cluster randomised controlled superiority trial (ISRCTN 95702682). Practices were recruited from four English regions and allocated (1:1) to intervention or control. Individuals receiving limited input in secondary care or who were under primary care only were eligible. The 12-month PARTNERS intervention incorporated person centred coaching support and liaison work. The primary outcome was change in Manchester Short Assessment of Quality of Life (MANSA). Results: We allocated 39 general practices, with 198 participants, to the PARTNERS intervention (20 practices; 116 participants) or control (19 practices; 82 participants). Primary outcome data were available for 99 (85.3%) intervention and 71 (86.6%) control participants. Mean change in overall MANSA score did not differ between the groups (0.25 (s.d. 0.73) for intervention vs 0.21 (s.d. 0.86) for control); estimated fully adjusted between-group difference 0.03, 95% CI -0.25 to 0.31; p=0.819. Acute mental health episodes (safety outcome) included three crises among those receiving the intervention and four among those not. Conclusion: There was no evidence of a difference in quality of life, as measured with the MANSA, between those receiving the PARTNERS intervention and usual care. Shifting care to primary care was not associated with increased adverse outcomes.</p