Integrated care for people with long-term mental and physical health conditions in low-income and middle-income countries

May combine two claims.

In other similar studies, positive effects have been shown for people with depression, chronic obstructive pulmonary disease, asthma, diabetes and heart failure.

“In other similar studies, positive effects have been shown for people with depression 34 35 , chronic obstructive pulmonary disease 35 , asthma 35 36 , diabetes 35 36 and heart failure 36 .”

• cites [34] Lin, 2012, Treatment adjustment and medication adherence for complex patients with diabetes, heart disease, and depression: a randomized controlled trial, Ann Fam Med sourceNot checked yet

  Not checked in the free run.

• cites [35] Kadu, 2015, Facilitators and barriers of implementing the chronic care model in primary care: a systematic review, BMC Fam Pract sourceNot checked yet

  Not checked in the free run.

• cites [36] Desmedt, 2016, Economic impact of integrated care models for patients with chronic diseases: a systematic review, Value Health sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

It is not clear whether all the components of the chronic care model are necessary, or whether some components are more effective than others.

“It is not clear whether all the components of the chronic care model are necessary, or whether some components are more effective than others 34 .”

• cites [34] Lin, 2012, Treatment adjustment and medication adherence for complex patients with diabetes, heart disease, and depression: a randomized controlled trial, Ann Fam Med sourceNot checked yet

  Not checked in the free run.

May combine two claims.

The economic outcomes reported are somewhat less consistent, but tend to show an overall positive impact on cost reduction.

“The economic outcomes reported are somewhat less consistent, but tend to show an overall positive impact on cost reduction 36 .”

• cites [36] Desmedt, 2016, Economic impact of integrated care models for patients with chronic diseases: a systematic review, Value Health sourceNot checked yet

  Not checked in the free run.

May combine two claims.

The TeamCare trial evaluated a collaborative integrated care model for patients with diabetes and/or heart disease and depression in community-based primary care clinics in Washington State and demonstrated improved physical and mental health outcomes compared to care as usual.

“such as the TeamCare trial which evaluated a collaborative integrated care model for patients with diabetes and/or heart disease and depression in community-based primary care clinics in Washington State and demonstrated improved physical and mental health outcomes when compared to care as usual 30-32 33”

• cites [30] Coleman, 2009, Evidence on the Chronic Care Model in the new millennium, Health Aff (Millwood) sourceNot checked yet

  Not checked in the free run.

• cites [31] Katon, 2010, Collaborative care for patients with depression and chronic illnesses, N Engl J Med sourceNot checked yet

  Not checked in the free run.

• cites [32] Katon, 2010, Integrating depression and chronic disease care among patients with diabetes and/or coronary heart disease: the design of the TEAMcare study, Contemp Clin Trials sourceNot checked yet

  Not checked in the free run.

• cites [33] Wozniak, 2015, Contextualizing the effectiveness of a collaborative care model for primary care patients with diabetes and depression (Teamcare): a qualitative assessment using RE-AIM, Can J Diabetes sourceNot checked yet

  Not checked in the free run.

May combine two claims.

Integrated chronic care models in high income settings tend to produce improvements in quality of care and in patient outcomes.

“the overall findings are largely consistent and show that integrated chronic care models, in high income settings, do indeed tend to produce improvements in quality of care 28 and in patient outcomes 29”

• cites [28] Unutzer, 2008, Long-term cost effects of collaborative care for late-life depression, Am J Manag CareNot checked yet

  Not checked in the free run.

• cites [29] Ouwens, 2005, Integrated care programmes for chronically ill patients: a review of systematic reviews, Int J Qual Health Care sourceNot checked yet

  Not checked in the free run.

May combine two claims.

Evaluations of the impact of the integrated chronic care model have so far been largely limited to HICs, and have mostly reported patient-level outcomes rather than facility/district or whole system outcomes.

“Evaluations of the impact of the integrated chronic care model have so far been largely limited to HICs, and have mostly reported at the patient level (micro), rather than facility/district (meso) level or whole system (macro) level outcomes 26”

• cites [26] Wagner, 2001, Improving chronic illness care: translating evidence into action, Health Aff (Millwood) sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing).

Once duplicates were removed, 910 articles were reviewed.

“Once duplicates were removed, 910 articles were reviewed.”

May combine two claims.

Of the studies, four were conducted in low-income countries (Pakistan, Zanzibar, Nepal, Ethiopia), five in lower-middle income countries (India, Kenya, Brazil, and Costa Rica) and two in upper-middle income countries (Jamaica, South Africa).

“Of the studies, four were conducted in low-income countries (Pakistan, Zanzibar, Nepal, Ethiopia), five in lower-middle income countries (India, Kenya, Brazil, and Costa Rica) and two in upper-middle income countries (Jamaica, South Africa).”

May combine two claims.

A review of chronic care programmes in the Philippines showed that this approach is feasible, but only if certain conditions are met: incorporation of chronic care throughout the health system; acceptance by health care staff of these responsibilities, facilitated by task sharing; ensuring that patients receive education to support self-care; and using health promotion activities in the general人口,

“A review of chronic care programmes in the Philippines also showed that this approach is feasible, but only if certain conditions are met, namely: (i) incorporation of chronic care throughout the health system; (ii) acceptance by health care staff of these responsibilities, facilitated by task sharing; (iii) ensuring that patients receive education to support self-care; and (iv) using health”

• cites [42] Ku, 2015, Adapting chronic care models for diabetes care delivery in low-and-middle-income countries: a review, World J Diabetes sourceNot checked yet

  Not checked in the free run.

Classified as probably not a substantial claim.

We identified few review papers related to the effectiveness of chronic care models in LMICs in the conceptual overview.

“As we identified few review papers related to the effectiveness of chronic care models in LMICs in this conceptual overview”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The excluded articles (n = 819) were mostly in the definite exclusion category (n=813), while some targeted physical chronic conditions only (n=38), some described low income groups within high income settings (n=18), and other papers (n=17) had a high-income country focus.

“The excluded articles (n = 819) were mostly in the definite exclusion category (n=813), while some of them targeted physical chronic conditions only (n=38), some described low income groups within high income settings (n= 18) while other papers (n = 17) had a high-income country focus.”

May combine two claims.

The South Africa trial did show some important secondary effects including positive impacts on evidence-informed prescribing for diabetes (in those with moderately uncontrolled disease - baseline HBA1C between 7 and 10%) and cardiovascular risk (increased provision of statins to patients with high body mass index, increased provision of aspirin to those with diabetes).

“It did, however, show some important secondary effects including positive impacts on evidence-informed prescribing for diabetes (in those with moderately uncontrolled disease -baseline HBA1C between 7 and 10%) and cardiovascular risk (increased provision of statins to patients with high body mass index, increased provision of aspirin to those with diabetes).”

May combine two claims.

Interventions that used systematic methods to identify patients with depression, and trials that included patients with a chronic physical condition, reported improved use of anti-depressant medication.

“Interventions that used systematic methods to identify patients with depression, and also trials that included patients with a chronic physical condition reported improved use of anti-depressant medication 38 .”

• cites [38] Coventry, 2014, Characteristics of effective collaborative care for treatment of depression: a systematic review and meta-regression of 74 randomised controlled trials, PLoS One sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing).

Through snowballing and hand searching, 23 reports and book chapters were also identified.

“Through snowballing and hand searching, 23 reports and book chapters were also identified.”

May combine two claims.

Overall, we identified some evidence in favour of the impact of integrated chronic care models, although the quality of the data was rather weak, as assessed using the Cochrane risk of bias tool, and only eight studies included an explicit evaluative component.

“Overall, we identified some evidence in favour of the impact of integrated chronic care models, although the quality of the data was rather weak, as assessed using the Cochrane risk of bias tool 67 , and only eight studies included an explicit evaluative component.”

• cites [67]Not checked yet

  Not checked in the free run.

May combine two claims. The quote only partly states this claim.

Low levels of preparedness often referred to the lack of multi-disciplinary teams within primary care, insufficient training for staff on the management of people with long-term conditions, insufficient capacity to provide long-term follow-up, treatment inertia and limited efforts to 'treat to target', poor understanding of integrated care by health insurers, insufficient or fragmented health信息

“This often referred to the lack of multi-disciplinary teams within primary care 58,61 , insufficient training for staff on the management of people with long-term conditions 57 , insufficient capacity to provide long-term follow-up and make sure that people don't 'fall through the cracks', treatment inertia and limited efforts to 'treat to target' 33 , poor understanding of integrated care by”

• cites [58] Oldenburg, 2014, Public health perspectives on the co-occurrence of non-communicable diseases and common mental disordersNot checked yet

  Not checked in the free run.

• cites [61] Sartorius, 2015Not checked yet

  Not checked in the free run.

• cites [57] Narayanan, 2012, Integrating mental health into cardiovascular disease research in India, Natl Med J IndiaNot checked yet

  Not checked in the free run.

May combine two claims.

The BasicNeeds model, a social intervention that integrates employment with the care and treatment of mental disorders, is cost effective and accessible to community members particularly vulnerable due to their symptoms and poverty.

“The BasicNeeds model, a social intervention that integrates employment with the care and treatment of mental disorders, is cost effective and accessible to community members particularly vulnerable due to their symptoms and poverty 47 70 .”

• cites [47] de Menil, 2015, Cost-effectiveness of the Mental Health and Development model for schizophrenia-spectrum and bipolar disorders in rural Kenya, Psychol Med sourceNot checked yet

  Not checked in the free run.

• cites [70] Petersen, 2010, Integrating mental health into primary health care: lessons from pilot district demonstration sites in Uganda and South Africa, S Afr J PsychiatryNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing).

Overall 1266 papers were identified from the databases.

“Overall 1266 papers were identified from these databases”

May combine two claims.

Several of the papers assessed health system preparedness for integrated care, in general finding low levels of preparedness.

“Several of the papers assessed this issue, in general finding low levels of preparedness 50 .”

• cites [50] Hanlon, 2014, Challenges and opportunities for implementing integrated mental health care: a district level situation analysis from five low- and middle-income countries, PLoS One sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing).

An innovative project in Jamaica suggested that integrating community mental health service provision within primary care improves public attitudes towards people with mental illness.

“An innovative project in Jamaica suggested that integrating community mental health service provision within primary care improves public attitudes towards people with mental illness.”

May combine two claims.

Within LMICs, the key elements of the collaborative care model for people with common mental disorders are case screening, providing psychosocial treatments and adherence management; access to essential medicines; support of visiting psychiatrists, and active patient follow up.

“Within LMICs several studies have aimed to identify the active ingredients of the collaborative care model and, to date, the key elements for people with common mental disorders are: case screening, providing psychosocial treatments and adherence management; access to essential medicines; support of visiting psychiatrists, and active patient follow up 43 32 .”

• cites [43] Pereira, 2011, The integration of the treatment for common mental disorders in primary care: experiences of health care providers in the MANAS trial in Goa, India, Int J Ment Health Syst sourceNot checked yet

  Not checked in the free run.

• cites [32] Katon, 2010, Integrating depression and chronic disease care among patients with diabetes and/or coronary heart disease: the design of the TEAMcare study, Contemp Clin Trials sourceNot checked yet

  Not checked in the free run.

Classified as probably not a substantial claim.

Far less information is available on the application and the effectiveness of integrated care in LMICs.

“Yet far less information is available on the application and the effectiveness of integrated care in LMICs.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The authors of the South Africa trial noted that these trial findings assessing the effectiveness of complex interventions in real world settings were difficult to interpret and noted several challenges including a co-intervention, called the Chronic Disease Season, triggered by the trial, and not expanding access to antidepressant prescribing or psychological therapies.

“The authors noted that these trial findings assessing the effectiveness of complex interventions in real world settings, were difficult to interpret and noted several challenges including a co-intervention, called the Chronic Disease Season, triggered by the trial, and not expanding access to antidepressant prescribing or psychological therapies 41 68 .”

• cites [41] Fairall, 2016, Educational outreach with an integrated clinical tool for nurse-led non-communicable chronic disease management in primary care in South Africa: a pragmatic cluster randomised controlled trial, PLoS Med sourceNot checked yet

  Not checked in the free run.

• cites [68] Armijo-Olivo, 2012, Assessment of study quality for systematic reviews: a comparison of the Cochrane Collaboration Risk of Bias Tool and the Effective Public Health Practice Project Quality Assessment Tool: methodological research, J Eval Clin Pract sourceNot checked yet

  Not checked in the free run.

May combine two claims.

A small majority of studies (13/21) focused on integrating mental health with other chronic physical conditions at primary care level, two emphasised integrating mental health with sustainable livelihood, and the rest highlighted integration of mental health with HIV, neurological disorders, malnutrition and cardiovascular diseases.

“A small majority of studies (13/21) focused on integrating mental health with other chronic physical conditions at primary care level, two emphasised integrating mental health with sustainable livelihood, and the rest highlighted integration of mental health with HIV, neurological disorders, malnutrition and cardiovascular diseases.”

May combine two claims.

Work in Zanzibar concluded that health sector reforms focus on communicable diseases, and that specialists in these fields were resistant to include mental health in these reforms.

“Yet work in Zanzibar concluded that health sector reforms focus on communicable diseases, and that specialists in these fields were resistant to include mental health in these reforms 52 .”

• cites [52] Jenkins, 2011, Developing and implementing mental health policy in Zanzibar, a low income country off the coast of east Africa, Int J Ment Health Syst sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Fifteen of the sources reported collected qualitative data, five quantitative data and one reported both.

“Fifteen of the sources reported collected qualitative data, five quantitative data and one reported both.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Of the 21 studies, two were randomised control trials, nine were cross-sectional studies, two were systematic reviews, and the remaining eight were descriptive/narrative reviews.

“of the 21 studies, two were randomised control trials, nine were cross-sectional studies, two were systematic reviews, and the remaining eight were descriptive/narrative reviews.”

Probably not a substantial claim: may not pass S3 (load-bearing).

A total of 21 papers (18 research papers and 3 book chapters) were included in the final review.

“A total of 21 papers (18 research papers and 3 book chapters) were included in the final review”

May combine two claims.

Integrated care has not been very substantially examined for any effect on stigma reduction, and the indirect evidence on this issue is conflicting.

“Integrated care has not been very substantially examined for any effect on stigma reduction, and the indirect evidence on this issue is conflicting.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

A total of 933 papers, chapters and reports were selected for title abstract screening, from which 57 were selected for full-text review.

“Hence a total of 933 papers, chapters and reports were selected for title abstract screening, from which 57 were selected for full-text review.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Most studies were recent: eight were published between 2008 and 2012 and 13 between 2013 and 2017.

“Most studies were recent: eight were published between 2008 and 2012 and 13 between 2013 and 2017.”

Probably not a substantial claim: may not pass S3 (load-bearing), S4 (based). May combine two claims.

Limited understanding of system-wide data and inaccurate reporting derail accountability mechanisms.

“Limited understanding of system-wide data and inaccurate reporting derail accountability mechanisms”

May combine two claims.

Two important studies in South Africa found that integrated care, in particular shared waiting rooms for all people with chronic conditions, was reported by staff to reduce discrimination and to increase access to care among people with HIV/AIDS.

“Two important studies in South Africa found that integrated care, in particular shared waiting rooms for all people with chronic conditions, was reported by staff to reduce discrimination and to increase access to care among people with HIV/AIDS 71,72 .”

• cites [71] Astbury, 2008Not checked yet

  Not checked in the free run.

• cites [72] Mathibe, 2015, Clinician perceptions and patient experiences of antiretroviral treatment integration in primary health care clinics, Tshwane, South Africa, Curationis sourceNot checked yet

  Not checked in the free run.

May combine two claims.

Evaluations of cost-effectiveness are few in LMICs, as are methods to allow modelling to estimate future costs and benefits of integrated care.

“Evaluations of cost-effectiveness are few in LMICs 73 , as are methods to allow modelling to estimate future costs and benefits of integrated care 74,75 .”

• cites [73] Ameh, 2017, Quality of integrated chronic disease care in rural South Africa: user and provider perspectives, Health Policy PlanNot checked yet

  Not checked in the free run.

• cites [74] Mendenhall, 2014, Acceptability and feasibility of using non-specialist health workers to deliver mental health care: stakeholder perceptions from the PRIME district sites in Ethiopia, India, Nepal, South Africa, and Uganda, Soc Sci Med sourceNot checked yet

  Not checked in the free run.

• cites [75] Petersen, 2017, Strengthening mental health system governance in six low- and middle-income countries in Africa and South Asia: challenges, needs and potential strategies, Health Policy Plan sourceNot checked yet

  Not checked in the free run.

May combine two claims.

Limited human resources and even more limited mental health human resources are both the rationale for, and a limitation upon, integrated care.

“Limited human resources and even more limited mental health human resources are both the rationale for, and a limitation upon, integrated care.”

May combine two claims.

People living with HIV/AIDS have a marked increase in the likelihood of becoming depressed, using alcohol, tobacco or other addictive substances, and are at higher risk for experiencing a cardiovascular event.

“People living with HIV/AIDS, for example, have a marked increase in the likelihood of becoming depressed, using alcohol, tobacco or other addictive substances, and are also at a higher risk for experiencing a cardiovascular event 8 .”

• cites [8] 2014Not checked yet

  Not checked in the free run.

May combine two claims.

At present, health systems worldwide are poorly organized to respond to the needs of people with NCDs and other long-term conditions, as they were mainly developed to respond to people in need of urgent or episodic care, usually with single health conditions.

“At present, health systems worldwide are poorly organized to respond to the needs of people with NCDs and other long-term conditions, as they were mainly developed to respond to people in need of urgent or episodic care, usually with single health conditions 17 .”

• cites [17] Topp, 2018, How to assess and prepare health systems in low- and middle-income countries for integration of services-a systematic review, Health Policy Plan sourceNot checked yet

  Not checked in the free run.

May combine two claims.

Food insecurity contributes to risky sexual practices and enhanced transmission of HIV.

“Food-insecurity, for instance, contributes to risky sexual practices and enhanced transmission of HIV.”

• cites [14] Weiser, 2011, Conceptual framework for understanding the bidirectional links between food insecurity and HIV/AIDS, Am J Clin Nutr sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing).

The global pattern of the burden of disease is changing.

“The global pattern of the burden of disease is changing 1 2 .”

• cites [1] 2016, Global, regional, and national life expectancy, all-cause mortality, and cause-specific mortality for 249 causes of death, 1980–2015: a systematic analysis for the Global Burden of Disease Study 2015, Lancet sourceNot checked yet

  Not checked in the free run.

• cites [2] Beaglehole, 2008, Improving the prevention and management of chronic disease in low-income and middle-income countries: a priority for primary health care, Lancet sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

NCDs place a heavy economic burden on countries; the annual lost productivity attributable to depression and anxiety disorders worldwide was estimated in 2013 to be US$900 billion.

“NCDs also place a heavy economic burden on countries, with the annual lost productivity attributable to depression and anxiety disorders worldwide, for example, estimated in 2013 to be US$ 900 billion 6 .”

• cites [6] Chisholm, 2016, Scaling-up treatment of depression and anxiety: a global return on investment analysis, Lancet Psychiatry sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing).

The chronic care model was initially articulated by Wagner et al.

“One such approach was initially articulated by Wagner et al as the 'chronic care model' 18 .”

• cites [18] Wagner, 1996, Organizing care for patients with chronic illness, Milbank Q sourceNot checked yet

  Not checked in the free run.

May combine two claims.

Long-term physical and mental conditions share common disease determinants and consequences, and bidirectional pathways, so that one type of morbidity may be both a determinant and/or a consequence of another.

“These reciprocal relationships mean that long-term physical and mental conditions share common disease determinants and consequences, and also bidirectional pathways, so that one type of morbidity may be both a determinant and or a consequence of another 9”

• cites [9] Patel, 2015, Integrating mental health in care for noncommunicable diseases: an imperative for person-centered care, Health Aff (Millwood) sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing).

Life expectancy from birth increased from 61.7 years in 1980 to 71.8 years in 2015.

“Globally, life expectancy from birth increased from 61.7 years (95% uncertainty interval 61.4-61.9) in 1980 to 71.8 years (71.5-72.2) in 2015, 4”

• cites [4] O'Neil, 2015, A shared framework for the common mental disorders and non-communicable disease: key considerations for disease prevention and control, BMC Psychiatry sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The costs of diabetes are projected to rise to at least US$745 billion in 2030, with LMICs assuming a much greater share of these economic losses than HICs.

“The costs of diabetes, for example, are projected to rise to at least US$ 745 billion in 2030, with LMICs assuming a much greater share of these economic losses than HICs 7 .”

• cites [7] Bloom, 2011Not checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing).

Two researchers reached consensus on whether resources identified from the grey literature were eligible for inclusion.

“Two researchers reached consensus on whether resources identified from the grey literature were eligible for inclusion.”

• Also stated in: § Additional information · plain

  “Two researchers reached consensus on whether resources identified from the grey literature were eligible for inclusion.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The assessment for inclusion was divided among two pairs of researchers, and where there was disagreement during full-text review, the decision of whether to include the report was independently made by a third researcher.

“This assessment was divided among two pairs of researchers.Where there was disagreement between the reviewers during full-text review, the decision of whether to include the report was independently made by a third researcher.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The review used the PRISMA checklist.

“using the PRISMA checklist 45 .”

• cites [45] Moher, 2009, Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement, PLoS Med sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing).

The inter-rater reliability (kappa) between reviewers was 0.80.

“The inter-rater reliability (kappa) between reviewers was 0.80.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Four researchers carried out the review.

“four researchers carried out the review”

Classified as probably not a substantial claim.

The search used terms describing chronic care or integrated care models, long-term mental health conditions or multiple chronic conditions, evaluation or research, and LMICs or developing countries, from inception to February 2017.

“using (terms describing chronic care or integrated care models) and (terms describing longterm mental health conditions or multiple chronic conditions) and (terms describing evaluation or research etc.) and (terms describing LMICs or developing countries), from inception to February 2017.”

Probably not a substantial claim: may not pass S3 (load-bearing).

The findings from this narrative review of recent LMIC studies of integrated care are fully aligned with the results of the conceptual overview of this field.

“The findings from this narrative review of recent LMIC studies of integrated care are fully aligned with the results of our conceptual overview of this field.”

May combine two claims.

Poor mental health literacy and stigma, and fear of being overwhelmed by clinical challenges that workers are not prepared for, may be a limiting factor in the uptake of such training.

“Poor mental health literacy and stigma, and fear of being overwhelmed by clinical challenges that workers are not prepared for, may be a limiting factor in the uptake of such training 99,100 .”

• cites [99] Menezess, 2015, The Latin American treatment and innovation network in mental health (LATINMH): rationale and scope, Rev Fac Cien Med Univ Nac Cordoba sourceNot checked yet

  Not checked in the free run.

• cites [100] Abayneh, 2017, Service user involvement in mental health system strengthening in a rural African setting: qualitative study, BMC Psychiatry sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing).

The assessment was divided among two pairs of researchers.

“This assessment was divided among two pairs of researchers.”

Probably not a substantial claim: may not pass S2 (checkable), S4 (based).

A key outcome of this transformation would be continuity of care.

“A key outcome of this transformation would be continuity of care.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Three search engines were accessed: Medline, Embase, and PsycInfo.

“three search engines were accessed, Medline, Embase and PsycInfo”

Classified as probably not a substantial claim.

The literature review included any publication that provided either a description or an evaluation of the chronic care model, ICCCF model, or integrated health care for chronic/long-term physical conditions and mental disorders.

“Any publication that provided either a description or an evaluation of either the chronic care model, ICCCF model or integrated health care for chronic / long-term physical conditions and mental disorders.”

Probably not a substantial claim: may not pass S2 (checkable), S3 (load-bearing), S4 (based).

There is potential for reverse innovation, with lessons from making services more comprehensive in LMICs being translated back into high-income countries.

“There is also now the potential for reverse innovation -with lessons generated through having to make services more comprehensive within the context of LMICs being translated back into HICs.”

Probably not a substantial claim: may not pass S2 (checkable).

A fundamental service transformation may be necessary to achieve an integrated system of care that empowers patients and providers, delivers better quality of care, and improves health, economic and social outcomes for people with chronic physical and mental conditions.

“For these reasons, a fundamental service transformation may be necessary in order to achieve an integrated system of care that empowers patients and providers, delivers a better quality of care, and brings about improved health, economic and social outcomes for people with chronic physical and mental conditions.”

• AssumptionRests on an assumption: Health information systems in LMICs are frequently unlinked, incomplete, with little quality assurance, low investment, poor information governance, and with few relevant or useful mental health indicators collected.
• AssumptionRests on an assumption: In under-resourced systems, there is a lack of coordination of what to collect across the system and a lack of understanding of the relevance of data.
• AssumptionRests on an assumption: Insufficient training of clinicians leads to poor quality data in information systems, giving available data limited utility.

Probably not a substantial claim: may not pass S3 (load-bearing).

Where there was disagreement between reviewers during full-text review, the decision of whether to include the report was independently made by a third researcher.

“Where there was disagreement between the reviewers during full-text review, the decision of whether to include the report was independently made by a third researcher.”

May combine two claims.

A more recent Cochrane review of psychosocial interventions for people with both severe mental illness and substance misuse identified 32 trials, but found no significant additional benefit in outcomes from adding psychosocial treatments.

“Similarly, a more recent Cochrane review of psychosocial interventions for people with both severe mental illness and substance misuse identified 32 trials, but found no significant additional benefit in outcomes from adding psychosocial treatments 113 .”

• cites [113]Not checked yet

  Not checked in the free run.

May combine two claims.

Clear positive impacts on health worker morale have been documented in parallel qualitative evaluations, with non-physician clinicians reporting empowerment and improved agency to manage patients.

“Clear positive impacts on health worker morale have been documented in parallel qualitative evaluations, with non-physician clinicians reporting a sense of empowerment and improved agency to manage patients 92,93 .”

• cites [92] Zwarenstein, 2011, Outreach education for integration of HIV/AIDS care, antiretroviral treatment, and tuberculosis care in primary care clinics in South Africa: PALSA PLUS pragmatic cluster randomised trial, BMJ sourceNot checked yet

  Not checked in the free run.

• cites [93] Fairall, 2012, Task shifting of antiretroviral treatment from doctors to primary-care nurses in South Africa (STRETCH): a pragmatic, parallel, cluster-randomised trial, Lancet sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S2 (checkable). May combine two claims.

Changes to integrate care are not trivial and may require fundamentally restructuring health care provision that in many countries is mainly organised to respond to acute, single conditions.

“We have indicated that such changes are not trivial, and may require fundamentally restructuring health care provision that in many countries is mainly organised to respond to acute, single conditions.”

May combine two claims.

PACK has been introduced throughout South Africa, and precursors piloted in Malawi and Botswana.

“PACK has been introduced throughout South Africa, and precursors piloted in Malawi and Botswana 94,95 .”

• cites [94] Stein, 2008, Building capacity for antiretroviral delivery in South Africa: a qualitative evaluation of the PALSA PLUS nurse training programme, BMC Health Serv Res sourceNot checked yet

  Not checked in the free run.

• cites [95] Georgeu, 2012, Implementing nurse-initiated and managed antiretroviral treatment (NIMART) in South Africa: a qualitative process evaluation of the STRETCH trial, Implement Sci sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing).

Integrated care may mean supporting staff in primary health care clinics to gain clinical skills and confidence to treat mental illnesses, as in North West Province South Africa within the COBALT and PRIME trials.

“Conversely, integrated care may mean supporting staff in primary health care clinics to gain the clinical skills and confidence to treat mental illnesses among the clinical cases treated, such as in clinics in the North West Province of South Africa within the COBALT and PRIME trials 80,81 (see Figure 3).”

• cites [80]Not checked yet

  Not checked in the free run.

• cites [81] Fairall, 2018, Collaborative care for the detection and management of depression among adults receiving antiretroviral therapy in South Africa: study protocol for the CobALT randomised controlled trial, Trials sourceNot checked yet

  Not checked in the free run.

May combine two claims.

Both the narrative review and the conceptual overview confirm that health systems are poorly configured to deal with chronic care needs, as has been shown by the recent Disease Control Priorities (DCP) mental health group.

“Both sources confirm that health systems are poorly configured to deal with chronic care needs, as has been shown by the recent Disease Control Priorities (DCP) mental health group 76 .”

• cites [76] Patel, 2016, Addressing the burden of mental, neurological, and substance use disorders: key messages from Disease Control Priorities, 3rd edition, Lancet sourceNot checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Papers, book chapters, and programme documents were assessed for inclusion first through title and abstract screening, and subsequently through full text review where relevance could not be established from the title or abstract, using the PRISMA checklist.

“Papers, book chapters and programme documents were assessed for inclusion, first through title and abstract screening, and subsequently through a full text review of those papers where relevance could not be established from the title or abstract, using the PRISMA checklist 45 .”

• cites [45] Moher, 2009, Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement, PLoS Med sourceNot checked yet

  Not checked in the free run.

Classified as probably not a substantial claim. May combine two claims.

The review initially aimed to include only papers with an evaluative component, but due to scarcity, it also included descriptive papers.

“While we initially aimed to only include papers with an evaluative component, due to the scarcity, we decided to also include those that were descriptive in nature.”

• AssumptionRests on an assumption: There was a scarcity of papers with an evaluative component on integrated care for long-term mental and physical health conditions in LMICs.

May combine two claims.

Co-occurring mental illness and substance use disorders has long been recognised, and can complicate the treatment of both mental illness and the substance use disorder.

“This particular combination of co-occurring conditions has long been recognised, and can complicate the treatment of both mental illness and the SUD 111 .”

• cites [111]Not checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing).

For qualitative studies, a twelve point review criteria were used.

“for qualitative studies a twelve point review criteria 106,107 were used.”

• cites [106]Not checked yet

  Not checked in the free run.

• cites [107] Kebede, 2016, Ask patients “What matters to you?” rather than “What's the matter?”, BMJ sourceNot checked yet

  Not checked in the free run.

Classified as probably not a substantial claim.

The inclusion criteria were any publication that provided either a descriptive or evaluative component, from an LMIC, written in English, referring to both severe mental illness and a comorbid chronic physical condition.

“The inclusion criteria were any publication that provided either a descriptive or evaluative component, from an LMIC, written in English, referring to both severe mental illness and a comorbid chronic physical condition.”

Classified as probably not a substantial claim. May combine two claims.

Excluded papers did not provide either a descriptive or scientific evaluative component, were from high-income countries, focused on chronic physical conditions, were in languages other than English, or were conference abstracts.

“Excluded papers did not provide either a descriptive or scientific evaluative component, were from high-income countries, focused on chronic physical conditions, were in languages other than English, or were conference abstracts.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Prior to commencement, a data extraction form was designed for use in the review.

“Prior to commencement, a data extraction form was designed for use in the review.”

Probably not a substantial claim: may not pass S3 (load-bearing).

For quantitative studies, the quality assessment tool developed by Effective Public Health Practice Project (EPHPP) was used.

“for the quantitative studies, the quality assessment tool developed by Effective Public Health Practice Project (EPHPP) 67”

• cites [67]Not checked yet

  Not checked in the free run.

Probably not a substantial claim: may not pass S3 (load-bearing).

From these ratings, each study was given a global rating of 'weak', 'moderate' or 'strong' evidence.

“From these ratings, each study was given a global rating of 'weak', 'moderate' or 'strong' evidence.”

Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

Further literature was searched for, including grey literature, by hand-searching reference lists, by snowballing through contacting experts, and by searching the internet.

“Further literature was searched for, including grey literature (e.g.books and non data-based papers), by hand-searching reference lists (for example in relevant reviews or journal papers); by using a snowballing process of contacting experts in the topic area; and by searching the internet (through Google and Google Scholar search engines, relevant organizational websites, and key journals).”