The DOI matches its Crossref record; 104 of the 106 references it cites were found in a registry or an index; 2 of the 91 sources its claims cite were checked for support.
Integrated care for people with long-term mental and physical health conditions in low-income and middle-income countries
Open accessAbstract
Integrated care is defined as health services that are managed and delivered such that people receive a continuum of health promotion, disease prevention, diagnosis, treatment, disease management, rehabilitation, and palliative care services, coordinated across the different levels and sites of care within and beyond the health sector and, according to their needs, throughout the life course. In this Review, we describe the most relevant concepts and models of integrated care for people with chronic (or recurring) mental illness and comorbid physical health conditions, provide a conceptual overview and a narrative review of the strength of the evidence base for these models in high-income countries and in low-income and middle-income countries, and identify opportunities to test the feasibility and effects of such integrated care models. We discuss the rationale for integrating care for people with mental disorders into chronic care; the models of integrated care; the evidence of the effects of integrating care in high-income countries and in low-income and middle-income countries; the key organisational challenges to implementing integrated chronic care in low-income and middle-income countries; and the practical steps to realising a vision of integrated care in the future.
Overview
AI snapshot
Written from the paper’s full text.
TL;DR
This narrative review describes integrated care models for people with long-term mental and physical conditions, finding that evidence for effectiveness is largely from high-income countries and remains scarce and mostly weak in low- and middle-income countries (LMICs). It identifies health-system strengthening, workforce training, financing, governance, and social interventions as key requirements for implementing integrated chronic care in LMICs.
Key findings
- The structured review identified 1266 database papers; after duplicates, 910 articles were screened, plus 23 grey-literature reports/book chapters, yielding 57 full-text reviews and 21 included papers (18 research papers, 3 book chapters), with reviewer kappa 0.80. Of the 21 studies, 2 were randomised controlled trials, 9 cross-sectional, 2 systematic reviews, and 8 descriptive/narrative; only 4 reported outcomes from evaluations of integrated care for mental illness and long-term physical conditions, and data quality was mostly weak.
- In high-income countries, integrated chronic care models tend to improve quality of care and patient outcomes; the TeamCare trial for diabetes and/or heart disease plus depression improved physical and mental health outcomes versus usual care. Economic outcomes were less consistent but tended toward positive cost reduction.
- In LMICs, evidence is far less available. A South African pragmatic cluster trial in 38 primary care clinics (Primary Care 101/PACK) did not show effectiveness on primary outcomes of treatment intensification for hypertension, diabetes, and chronic respiratory disease or depression case detection, but did show secondary benefits for evidence-informed diabetes prescribing and cardiovascular risk management.
- LMIC studies suggest integrated care is feasible only with health-system strengthening, clear staff roles, access to essential medicines and psychological treatments, and social interventions; key barriers include low health-system preparedness, lack of multidisciplinary teams, insufficient training, fragmented information systems, financing fragmentation, stigma, and weak governance.
Methods
- The paper combines a conceptual overview with a structured narrative review. Searches of Medline, Embase, and PsycInfo ran from inception to February 2017 using terms for chronic/integrated care, long-term mental or multiple chronic conditions, evaluation/research, and LMICs/developing countries; PRISMA was used, supplemented by grey literature, hand-searching, snowballing, and internet searches.
- Inclusion criteria were any publication with a descriptive or evaluative component, from an LMIC, written in English, referring to both severe mental illness and a comorbid chronic physical condition. Exclusions were no descriptive/scientific evaluative component, high-income country focus, physical chronic conditions only, non-English, or conference abstracts.
- Four researchers conducted the review in two pairs, with a third reviewer resolving full-text disagreements and two researchers reaching consensus on grey literature. Quality was assessed with the Effective Public Health Practice Project tool for quantitative studies and a 12-point criteria for qualitative studies, yielding global ratings of weak, moderate, or strong.
Limitations
- The paper states that evidence for integrated care is still scarce in LMICs, particularly for co-/multi-morbidities that include a mental disorder; the quality of data was rather weak, only eight studies included an explicit evaluative component, and cost-effectiveness evaluations are few in LMICs.
- The paper notes that lessons from high-income countries may not translate readily to LMICs, self-help and peer-support groups in mental health are poorly developed in many LMICs, and it is not yet clear whether primary and community care personnel are sufficiently prepared and supported for integrated mental health care.
- Evident from the text: this is a narrative review rather than a systematic meta-analysis; the search ended in February 2017 and was restricted to English-language publications; inclusion required both severe mental illness and a comorbid chronic physical condition, and many included studies were descriptive with no evaluation, limiting causal conclusions.
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Claims the paper makes
61 Not checked yet · 15 Own method · 13 Own result · 13 No basis given · 7 Own interpretation · 2 Supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“But the model was shown not to be effective for people with depression when delivered using training of health providers alone, without resourcing the health system to expand access to anti-depressants or psychological treatments identified as an additional pre-requisite 41 .”
§ Integrated care for people with long-term mental and physical conditions in low-and middle-income countries: narrative review > The impact of integrating care in low-and middle-income countries
What the sources say
- Supportedcites [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 source
The Discussion reports no effect on depression case detection and explicitly concludes that nurse training alone was insufficient to close the depression-care gap when access to counselling or antidepressant prescriptions was limited. This supports the claim's account of why the intervention did not improve depression care. (LLM, conf=0.92)
plain- Asserted: passes — The authors put it forward as true.
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None of the sources cited for this claim have been checked yet.
In the paper
“The majority of the studies concerned with mental-physical comorbidity have addressed people with common mental disorders (rather than severe mental illnesses)”
§ Integrated care for people with long-term mental and physical conditions in low-and middle-income countries: narrative review > The outcomes of integrating care in high income countries
What the sources say
- Not checked yetcites [30] Coleman, 2009, Evidence on the Chronic Care Model in the new millennium, Health Aff (Millwood) source
- Not checked yetcites [31] Katon, 2010, Collaborative care for patients with depression and chronic illnesses, N Engl J Med source
- Not checked yetcites [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 source
- Not checked yetcites [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 source
plain- Asserted: passes — The authors put it forward as true.
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In the paper
“The overall quality of these intervention studies is moderately strong 37 .”
§ Integrated care for people with long-term mental and physical conditions in low-and middle-income countries: narrative review > The outcomes of integrating care in high income countries
What the sources say
- Not checked yetcites [37] Martínez-González, 2014, Integrated care programmes for adults with chronic conditions: a meta-review, Int J Qual Health Care source
plain- Asserted: passes — The authors put it forward as true.
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In the paper
“Research papers more often tend to report clinical level variables (such as information given to patients to support self-management) than to assess organisational factors, such as professional culture, governance, financial management, communication patterns, implementation readiness, or presence of supportive leadership 35 .”
§ Integrated care for people with long-term mental and physical conditions in low-and middle-income countries: narrative review > The outcomes of integrating care in high income countries
What the sources say
- Not checked yetcites [35] Kadu, 2015, Facilitators and barriers of implementing the chronic care model in primary care: a systematic review, BMC Fam Pract source
plaincorrelational- Asserted: passes — The authors put it forward as true.
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In the paper
“a systematic review published in 2014 showed that trials of collaborative care that include psychological treatment, with or without anti-depressant medication, appear to improve depression more than those without psychological treatment.”
§ Integrated care for people with long-term mental and physical conditions in low-and middle-income countries: narrative review > The outcomes of integrating care in high income countries
What the sources say
- Not checked yetcites [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 source
hedgedconditional- Asserted: passes — The authors put it forward as true.
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In the paper
“although there is emerging evidence that well integrated care can reduce overall health care spending 27”
§ Integrated care for people with long-term mental and physical conditions in low-and middle-income countries: narrative review > The outcomes of integrating care in high income countries
What the sources say
- Not checked yetcites [27] Dauvrin, 2015, Is the chronic care model integrated into research examining culturally competent interventions for ethnically diverse adults with type 2 diabetes mellitus? A review, Eval Health Prof source
hedgedconditional- Asserted: passes — The authors put it forward as true.
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None of the sources cited for this claim have been checked yet.
In the paper
“Four studies examined this question.”
§ Integrated care for people with long-term mental and physical conditions in low-and middle-income countries: narrative review > Screening and case identification
plaindirect- Asserted: passes — The authors put it forward as true.
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In the paper
“In Pakistan integrated care was found to increase detection rates for diabetes mellitus, hypercholesterolemia, depression, osteoporosis and dementia in primary care 59 .”
§ Integrated care for people with long-term mental and physical conditions in low-and middle-income countries: narrative review > Screening and case identification
What the sources say
- Not checked yetcites [59] Patel, 2008, Preventive medicine practices by primary care providers in Karachi, J Coll Physicians Surg Pak
plaindirect- Asserted: passes — The authors put it forward as true.
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In the paper
“In Sao Paulo in Brazil, for example, the Equilibrium programme delivered a cost-effective multi-dimensional bio-psycho-social intervention treatment to children with both mal-nourishment and mental illness 66 .”
§ Integrated care for people with long-term mental and physical conditions in low-and middle-income countries: narrative review > Social interventions
What the sources say
- Not checked yetcites [66] Marques, 2015, Community-based global health program for maltreated children and adolescents in Brazil: the Equilibrium program, Front Psychiatry source
plaindirect- Asserted: passes — The authors put it forward as true.
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In the paper
“In South Africa, the chronic care model was shown to be feasible in primary care clinics only if there was a strong concurrent focus on health system strengthening, such as change management support for clinical staff and managers 40 .”
§ Integrated care for people with long-term mental and physical conditions in low-and middle-income countries: narrative review > The impact of integrating care in low-and middle-income countries
What the sources say
- Not checked yetcites [40] Mahomed, 2015, Development and implementation of an integrated chronic disease model in South Africa: lessons in the management of change through improving the quality of clinical practice, Int J Integr Care source
plainconditional- Asserted: passes — The authors put it forward as true.
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- Probably not a substantial claim. 45
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Every source the paper cites for this claim was checked and supports it.
In the paper
“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 .”
§ Integrated care for people with long-term mental and physical conditions in low-and middle-income countries: narrative review > Additional information
What the sources say
- Supportedcites [45] Moher, 2009, Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement, PLoS Med source
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plain- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
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None of the sources cited for this claim have been checked yet.
In the paper
“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 .”
§ Integrated care for people with long-term mental and physical conditions in low-and middle-income countries: narrative review > The outcomes of integrating care in high income countries
What the sources say
- Not checked yetcites [34] Lin, 2012, Treatment adjustment and medication adherence for complex patients with diabetes, heart disease, and depression: a randomized controlled trial, Ann Fam Med source
- Not checked yetcites [35] Kadu, 2015, Facilitators and barriers of implementing the chronic care model in primary care: a systematic review, BMC Fam Pract source
- Not checked yetcites [36] Desmedt, 2016, Economic impact of integrated care models for patients with chronic diseases: a systematic review, Value Health source
plaindirect- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
In the paper
“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 .”
§ Integrated care for people with long-term mental and physical conditions in low-and middle-income countries: narrative review > The outcomes of integrating care in high income countries
What the sources say
- Not checked yetcites [34] Lin, 2012, Treatment adjustment and medication adherence for complex patients with diabetes, heart disease, and depression: a randomized controlled trial, Ann Fam Med source
plain- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“The economic outcomes reported are somewhat less consistent, but tend to show an overall positive impact on cost reduction 36 .”
§ Integrated care for people with long-term mental and physical conditions in low-and middle-income countries: narrative review > The outcomes of integrating care in high income countries
What the sources say
- Not checked yetcites [36] Desmedt, 2016, Economic impact of integrated care models for patients with chronic diseases: a systematic review, Value Health source
hedgeddirect- Asserted: passes — The authors put it forward as true.
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None of the sources cited for this claim have been checked yet.
In the paper
“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”
§ Integrated care for people with long-term mental and physical conditions in low-and middle-income countries: narrative review > The outcomes of integrating care in high income countries
What the sources say
- Not checked yetcites [30] Coleman, 2009, Evidence on the Chronic Care Model in the new millennium, Health Aff (Millwood) source
- Not checked yetcites [31] Katon, 2010, Collaborative care for patients with depression and chronic illnesses, N Engl J Med source
- Not checked yetcites [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 source
- Not checked yetcites [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 source
boosteddirect- Asserted: passes — The authors put it forward as true.
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It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“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”
§ Integrated care for people with long-term mental and physical conditions in low-and middle-income countries: narrative review > The outcomes of integrating care in high income countries
What the sources say
- Not checked yetcites [28] Unutzer, 2008, Long-term cost effects of collaborative care for late-life depression, Am J Manag Care
- Not checked yetcites [29] Ouwens, 2005, Integrated care programmes for chronically ill patients: a review of systematic reviews, Int J Qual Health Care source
hedgedconditional- Asserted: passes — The authors put it forward as true.
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In the paper
“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”
§ Integrated care for people with long-term mental and physical conditions in low-and middle-income countries: narrative review > The outcomes of integrating care in high income countries
What the sources say
- Not checked yetcites [26] Wagner, 2001, Improving chronic illness care: translating evidence into action, Health Aff (Millwood) source
plain- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Once duplicates were removed, 910 articles were reviewed.”
§ Integrated care for people with long-term mental and physical conditions in low-and middle-income countries: narrative review > Results
plain- Asserted: passes — The authors put it forward as true.
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In the paper
“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).”
§ Integrated care for people with long-term mental and physical conditions in low-and middle-income countries: narrative review > Study design of reviewed papers
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In the paper
“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”
§ Integrated care for people with long-term mental and physical conditions in low-and middle-income countries: narrative review > The impact of integrating care in low-and middle-income countries
What the sources say
- Not checked yetcites [42] Ku, 2015, Adapting chronic care models for diabetes care delivery in low-and-middle-income countries: a review, World J Diabetes source
plainconditional- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“As we identified few review papers related to the effectiveness of chronic care models in LMICs in this conceptual overview”
§ Integrated care for people with long-term mental and physical conditions in low-and middle-income countries: narrative review > Method
plain- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Integrated care for people with long-term mental and physical conditions in low-and middle-income countries: narrative review > Results
plainn = 819- Asserted: passes — The authors put it forward as true.
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Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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).”
§ Integrated care for people with long-term mental and physical conditions in low-and middle-income countries: narrative review > Effectiveness of clinician training
plaindirect- Asserted: passes — The authors put it forward as true.
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In the paper
“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 .”
§ Integrated care for people with long-term mental and physical conditions in low-and middle-income countries: narrative review > The outcomes of integrating care in high income countries
What the sources say
- Not checked yetcites [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 source
plaindirect- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Through snowballing and hand searching, 23 reports and book chapters were also identified.”
§ Integrated care for people with long-term mental and physical conditions in low-and middle-income countries: narrative review > Results
plain- Asserted: passes — The authors put it forward as true.
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In the paper
“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.”
§ Integrated care for people with long-term mental and physical conditions in low-and middle-income countries: narrative review > Integrated primary health care
What the sources say
- Not checked yetcites [67]
hedgedconditional- Asserted: passes — The authors put it forward as true.
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In the paper
“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”
§ Integrated care for people with long-term mental and physical conditions in low-and middle-income countries: narrative review > Health system preparedness for integrated care
What the sources say
- Not checked yetcites [58] Oldenburg, 2014, Public health perspectives on the co-occurrence of non-communicable diseases and common mental disorders
- Not checked yetcites [61] Sartorius, 2015
- Not checked yetcites [57] Narayanan, 2012, Integrating mental health into cardiovascular disease research in India, Natl Med J India
plain- Asserted: passes — The authors put it forward as true.
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In the paper
“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 .”
§ Integrated care for people with long-term mental and physical conditions in low-and middle-income countries: narrative review > Social interventions
What the sources say
- Not checked yetcites [47] de Menil, 2015, Cost-effectiveness of the Mental Health and Development model for schizophrenia-spectrum and bipolar disorders in rural Kenya, Psychol Med source
- Not checked yetcites [70] Petersen, 2010, Integrating mental health into primary health care: lessons from pilot district demonstration sites in Uganda and South Africa, S Afr J Psychiatry
plaindirect- Asserted: passes — The authors put it forward as true.
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A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Overall 1266 papers were identified from these databases”
§ Integrated care for people with long-term mental and physical conditions in low-and middle-income countries: narrative review > Results
plain- Asserted: passes — The authors put it forward as true.
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In the paper
“Several of the papers assessed this issue, in general finding low levels of preparedness 50 .”
§ Integrated care for people with long-term mental and physical conditions in low-and middle-income countries: narrative review > Health system preparedness for integrated care
What the sources say
- Not checked yetcites [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 source
plain- Asserted: passes — The authors put it forward as true.
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The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“An innovative project in Jamaica suggested that integrating community mental health service provision within primary care improves public attitudes towards people with mental illness.”
§ Integrated care for people with long-term mental and physical conditions in low-and middle-income countries: narrative review > Stigma reduction
hedgeddirect- Asserted: passes — The authors put it forward as true.
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- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
None of the sources cited for this claim have been checked yet.
In the paper
“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 .”
§ Integrated care for people with long-term mental and physical conditions in low-and middle-income countries: narrative review > The impact of integrating care in low-and middle-income countries
What the sources say
- Not checked yetcites [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 source
- Not checked yetcites [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 source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Yet far less information is available on the application and the effectiveness of integrated care in LMICs.”
§ Integrated care for people with long-term mental and physical conditions in low-and middle-income countries: narrative review > The impact of integrating care in low-and middle-income countries
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
None of the sources cited for this claim have been checked yet.
In the paper
“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 .”
§ Integrated care for people with long-term mental and physical conditions in low-and middle-income countries: narrative review > Effectiveness of clinician training
What the sources say
- Not checked yetcites [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 source
- Not checked yetcites [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 source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Integrated care for people with long-term mental and physical conditions in low-and middle-income countries: narrative review > Integrated primary health care
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“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 .”
§ Integrated care for people with long-term mental and physical conditions in low-and middle-income countries: narrative review > Stigma reduction
What the sources say
- Not checked yetcites [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 source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Fifteen of the sources reported collected qualitative data, five quantitative data and one reported both.”
§ Integrated care for people with long-term mental and physical conditions in low-and middle-income countries: narrative review > Study design of reviewed papers
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Integrated care for people with long-term mental and physical conditions in low-and middle-income countries: narrative review > Study design of reviewed papers
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“A total of 21 papers (18 research papers and 3 book chapters) were included in the final review”
§ Integrated care for people with long-term mental and physical conditions in low-and middle-income countries: narrative review > Results
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“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 for people with long-term mental and physical conditions in low-and middle-income countries: narrative review > Stigma reduction
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Hence a total of 933 papers, chapters and reports were selected for title abstract screening, from which 57 were selected for full-text review.”
§ Integrated care for people with long-term mental and physical conditions in low-and middle-income countries: narrative review > Results
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Most studies were recent: eight were published between 2008 and 2012 and 13 between 2013 and 2017.”
§ Integrated care for people with long-term mental and physical conditions in low-and middle-income countries: narrative review > Integrated primary health care
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Limited understanding of system-wide data and inaccurate reporting derail accountability mechanisms”
§ Integrated care for people with long-term mental and physical conditions in low-and middle-income countries: narrative review > Barriers of human resources and skill
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds. It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“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 .”
§ Integrated care for people with long-term mental and physical conditions in low-and middle-income countries: narrative review > Stigma reduction
What the sources say
- Not checked yetcites [71] Astbury, 2008
- Not checked yetcites [72] Mathibe, 2015, Clinician perceptions and patient experiences of antiretroviral treatment integration in primary health care clinics, Tshwane, South Africa, Curationis source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“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 .”
§ Integrated care for people with long-term mental and physical conditions in low-and middle-income countries: narrative review > Stigma reduction
What the sources say
- Not checked yetcites [73] Ameh, 2017, Quality of integrated chronic disease care in rural South Africa: user and provider perspectives, Health Policy Plan
- Not checked yetcites [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 source
- Not checked yetcites [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 source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Limited human resources and even more limited mental health human resources are both the rationale for, and a limitation upon, integrated care.”
§ Integrated care for people with long-term mental and physical conditions in low-and middle-income countries: narrative review > Barriers of human resources and skill
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“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 .”
§ Integrated care for people with long-term mental and physical conditions in low-and middle-income countries: narrative review > The syndemics approach
What the sources say
- Not checked yetcites [8] 2014
plaincorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“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 .”
§ Integrated care for people with long-term mental and physical conditions in low-and middle-income countries: narrative review > Models of integrated care
What the sources say
- Not checked yetcites [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 source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“Food-insecurity, for instance, contributes to risky sexual practices and enhanced transmission of HIV.”
§ Integrated care for people with long-term mental and physical conditions in low-and middle-income countries: narrative review > The syndemics approach
What the sources say
- Not checked yetcites [14] Weiser, 2011, Conceptual framework for understanding the bidirectional links between food insecurity and HIV/AIDS, Am J Clin Nutr source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“The global pattern of the burden of disease is changing 1 2 .”
§ Integrated care for people with long-term mental and physical conditions in low-and middle-income countries: narrative review > Background
What the sources say
- Not checked yetcites [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 source
- Not checked yetcites [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 source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“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 .”
§ Integrated care for people with long-term mental and physical conditions in low-and middle-income countries: narrative review > Rationale for integrating care for people with severe mental disorders into chronic care
What the sources say
- Not checked yetcites [6] Chisholm, 2016, Scaling-up treatment of depression and anxiety: a global return on investment analysis, Lancet Psychiatry source
hedgeddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“One such approach was initially articulated by Wagner et al as the 'chronic care model' 18 .”
§ Integrated care for people with long-term mental and physical conditions in low-and middle-income countries: narrative review > Models of integrated care
What the sources say
- Not checked yetcites [18] Wagner, 1996, Organizing care for patients with chronic illness, Milbank Q source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“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”
§ Integrated care for people with long-term mental and physical conditions in low-and middle-income countries: narrative review > The syndemics approach
What the sources say
- Not checked yetcites [9] Patel, 2015, Integrating mental health in care for noncommunicable diseases: an imperative for person-centered care, Health Aff (Millwood) source
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
In the paper
“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”
§ Integrated care for people with long-term mental and physical conditions in low-and middle-income countries: narrative review > Rationale for integrating care for people with severe mental disorders into chronic care
What the sources say
- Not checked yetcites [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 source
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“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 .”
§ Integrated care for people with long-term mental and physical conditions in low-and middle-income countries: narrative review > Rationale for integrating care for people with severe mental disorders into chronic care
What the sources say
- Not checked yetcites [7] Bloom, 2011
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Integrated care for people with long-term mental and physical conditions in low-and middle-income countries: narrative review > Data extraction and review process
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
- Also stated in: § Additional information · plain
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Integrated care for people with long-term mental and physical conditions in low-and middle-income countries: narrative review > Data extraction and review process
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“using the PRISMA checklist 45 .”
§ Integrated care for people with long-term mental and physical conditions in low-and middle-income countries: narrative review > Data extraction and review process
What the sources say
- Not checked yetcites [45] Moher, 2009, Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement, PLoS Med source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“The inter-rater reliability (kappa) between reviewers was 0.80.”
§ Integrated care for people with long-term mental and physical conditions in low-and middle-income countries: narrative review > Results
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“four researchers carried out the review”
§ Integrated care for people with long-term mental and physical conditions in low-and middle-income countries: narrative review > Additional information
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Integrated care for people with long-term mental and physical conditions in low-and middle-income countries: narrative review > Additional information
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Integrated care for people with long-term mental and physical conditions in low-and middle-income countries: narrative review > Key organisational challenges in LMICs to implement integrated chronic care
boostedcorrelational- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
None of the sources cited for this claim have been checked yet.
In the paper
“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 .”
§ Integrated care for people with long-term mental and physical conditions in low-and middle-income countries: narrative review > Conclusions
What the sources say
- Not checked yetcites [99] Menezess, 2015, The Latin American treatment and innovation network in mental health (LATINMH): rationale and scope, Rev Fac Cien Med Univ Nac Cordoba source
- Not checked yetcites [100] Abayneh, 2017, Service user involvement in mental health system strengthening in a rural African setting: qualitative study, BMC Psychiatry source
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“This assessment was divided among two pairs of researchers.”
§ Integrated care for people with long-term mental and physical conditions in low-and middle-income countries: narrative review > Additional information
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“A key outcome of this transformation would be continuity of care.”
§ Integrated care for people with long-term mental and physical conditions in low-and middle-income countries: narrative review > Conclusions
hedgeddirect- Asserted: passes — The authors put it forward as true.
- Checkable: fails — It may be too vague to check against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. It may be too vague to check against evidence. The paper may give no reason why it holds.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“three search engines were accessed, Medline, Embase and PsycInfo”
§ Integrated care for people with long-term mental and physical conditions in low-and middle-income countries: narrative review > Additional information
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Integrated care for people with long-term mental and physical conditions in low-and middle-income countries: narrative review > Additional information
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Integrated care for people with long-term mental and physical conditions in low-and middle-income countries: narrative review > Conclusions
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: fails — It may be too vague to check against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: fails — The paper may give no reason why it holds.
Probably not a substantial claim. It may be too vague to check against evidence. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Integrated care for people with long-term mental and physical conditions in low-and middle-income countries: narrative review > Conclusions
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: fails — It may be too vague to check against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may be too vague to check against evidence.
- Rests 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.
- Rests 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.
- Rests on an assumption: Insufficient training of clinicians leads to poor quality data in information systems, giving available data limited utility.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Integrated care for people with long-term mental and physical conditions in low-and middle-income countries: narrative review > Additional information
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“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 .”
§ Integrated care for people with long-term mental and physical conditions in low-and middle-income countries: narrative review > Conclusions
What the sources say
- Not checked yetcites [113]
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“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 .”
§ Integrated care for people with long-term mental and physical conditions in low-and middle-income countries: narrative review > Practical steps for implementing integrated care
What the sources say
- Not checked yetcites [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 source
- Not checked yetcites [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 source
boosteddirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Integrated care for people with long-term mental and physical conditions in low-and middle-income countries: narrative review > Conclusions
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: fails — It may be too vague to check against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may be too vague to check against evidence. It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“PACK has been introduced throughout South Africa, and precursors piloted in Malawi and Botswana 94,95 .”
§ Integrated care for people with long-term mental and physical conditions in low-and middle-income countries: narrative review > Practical steps for implementing integrated care
What the sources say
- Not checked yetcites [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 source
- Not checked yetcites [95] Georgeu, 2012, Implementing nurse-initiated and managed antiretroviral treatment (NIMART) in South Africa: a qualitative process evaluation of the STRETCH trial, Implement Sci source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“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).”
§ Integrated care for people with long-term mental and physical conditions in low-and middle-income countries: narrative review > Practical steps for implementing integrated care
What the sources say
- Not checked yetcites [80]
- Not checked yetcites [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 source
hedgedconditional- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“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 .”
§ Integrated care for people with long-term mental and physical conditions in low-and middle-income countries: narrative review > Key organisational challenges in LMICs to implement integrated chronic care
What the sources say
- Not checked yetcites [76] Patel, 2016, Addressing the burden of mental, neurological, and substance use disorders: key messages from Disease Control Priorities, 3rd edition, Lancet source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Integrated care for people with long-term mental and physical conditions in low-and middle-income countries: narrative review > Additional information
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may state two separate claims as one.
- Rests 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.
In the paper
“This particular combination of co-occurring conditions has long been recognised, and can complicate the treatment of both mental illness and the SUD 111 .”
§ Integrated care for people with long-term mental and physical conditions in low-and middle-income countries: narrative review > Conclusions
What the sources say
- Not checked yetcites [111]
plaindirect- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: unclear — It is unclear whether the paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“for qualitative studies a twelve point review criteria 106,107 were used.”
§ Integrated care for people with long-term mental and physical conditions in low-and middle-income countries: narrative review > Additional information
What the sources say
- Not checked yetcites [106]
- Not checked yetcites [107] Kebede, 2016, Ask patients “What matters to you?” rather than “What's the matter?”, BMJ source
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Integrated care for people with long-term mental and physical conditions in low-and middle-income countries: narrative review > Additional information
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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.”
§ Integrated care for people with long-term mental and physical conditions in low-and middle-income countries: narrative review > Additional information
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: passes — The paper’s conclusions depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Prior to commencement, a data extraction form was designed for use in the review.”
§ Integrated care for people with long-term mental and physical conditions in low-and middle-income countries: narrative review > Additional information
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“for the quantitative studies, the quality assessment tool developed by Effective Public Health Practice Project (EPHPP) 67”
§ Integrated care for people with long-term mental and physical conditions in low-and middle-income countries: narrative review > Additional information
What the sources say
- Not checked yetcites [67]
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“From these ratings, each study was given a global rating of 'weak', 'moderate' or 'strong' evidence.”
§ Integrated care for people with long-term mental and physical conditions in low-and middle-income countries: narrative review > Additional information
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“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).”
§ Integrated care for people with long-term mental and physical conditions in low-and middle-income countries: narrative review > Additional information
plain- Asserted: passes — The authors put it forward as true.
- Checkable: passes — It can be checked against evidence.
- Load-bearing: fails — The paper’s conclusions may not depend on it.
- Based: passes — The paper gives a reason why it holds.
Probably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
The paper relies on this without support.
Health care systems traditionally focused on acute care now increasingly need to address chronic conditions.
“Health care systems, which traditionally focused on acute care, now increasingly need also to address the challenge of providing care for people with chronic conditions.”
The paper relies on this without support.
Long-term conditions require alternative approaches to the current health system organization.
“Long-term conditions require alternative approaches.”
The paper relies on this without support.
Current patterns of service delivery, especially the emphasis on in-patient care in many LMICs, dampen innovation.
“The inertia of current patterns of service delivery can also dampen innovation, such as the emphasis on in-patient care that remains predominant in many LMICs.”
The paper relies on this without support.
In many LMICs there is often no organizational culture valuing innovation or quality improvement, or leadership focused on staff development or change.
“There may be no organizational culture that values innovation or transformation of services, no culture for quality improvement, or a lack leadership focused on staff development or change.”
The paper relies on this without support.
Many women seeking care for chronic conditions also require family planning or antenatal care.
“Further, many women seeking care for chronic conditions will either also require family planning or antenatal care.”
The paper relies on this without support.
In many fragile health systems, family planning services are islands of organised care delivery within otherwise chaotic services, making them attractive entry points for integrated care.
“In many fragile health systems family planning services represent islands of organised care delivery within otherwise chaotic services, making them a very attractive entry point on which to build and strengthen integrated care.”
The paper relies on this without support.
Clinical guidelines tend to add a whole menu of essential assessments, advice and treatments with each additional condition, and when added up health providers can feel overwhelmed and not know what to prioritise.
“When these are added up, health providers can feel overwhelmed and not know what to prioritise.”
The paper relies on this without support.
Clinical specialists, donors and advocates tend to lobby for vertical services for single conditions, making prioritisation decisions difficult.
“Such decisions are difficult, especially where clinical specialists, donors and advocates tend to lobby for 'vertical' services for single conditions.”
The paper relies on this without support.
The value of the self, family and community care level in the ICCCF pyramid of care has not been investigated in LMICs.
“The ICCCF and similar approaches often propose a 'pyramid of care', starting with self and family and community care, where the value of this level of health support has not been investigated in LMICs.”
The paper relies on this without support.
Within LMICs it is not yet clear whether primary and community care health personnel are sufficiently prepared and supported to be trained to adopt a different role, becoming competent both for the treatment of people with long term physical and mental conditions.
“Within LMICs it is also not yet clear whether primary and community care health personnel are sufficiently prepared and supported to be trained to adopt a different role, becoming competent both for the treatment of people with long term physical and mental conditions.”
The paper relies on this without support.
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.
“systems are frequently unlinked, incomplete, with little quality assurance, low investment, poor information governance, and with few relevant or useful mental health indicators collected.”
The paper relies on this without support.
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.
“In under-resourced systems, there can be a lack of coordination of what to collect across the system as well as lack of understanding of the relevance of data.”
The paper relies on this without support.
Insufficient training of clinicians leads to poor quality data in information systems, giving available data limited utility.
“Insufficient training of clinicians can also lead to poor quality data in information systems, thus giving available data limited utility.”
The paper relies on this without support.
There was a scarcity of papers with an evaluative component on integrated care for long-term mental and physical health conditions in LMICs.
“due to the scarcity, we decided to also include those that were descriptive in nature.”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The source backs part of the claim, not all of it — or backs it for a different population, condition or comparison.
In the citing paper
“Delivering behavioral health interventions through health coaches has the added benefit of being cost-effective compared to repeat visits to licensed mental healthcare providers, i.e., psychiatrists or clinical psychologists, and can be particularly beneficial in low-income settings [28–30].”
From Personalized machine learning guided intervention for optimizing lifestyle behaviors in depression: a pilot study (2026) · cites this paper as [28]
Experimental — accuracy not yet measured
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
§ Integrated care for people with long-term mental and physical conditions in low-and middle-income countries: narrative review > Screening and case identification
“In Pakistan integrated care was found to increase detection rates for diabetes mellitus, hypercholesterolemia, depression, osteoporosis and dementia in primary care 59 .”
§ Integrated care for people with long-term mental and physical conditions in low-and middle-income countries: narrative review > Conclusions
“No evaluation reported Quantitative Higher screening reported for Diabetes Mellitus (92%) than hypercholesterolemia (73%), osteoporosis (46%), Depressive disorders (62%), Dementia (26%).”
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
§ Integrated care for people with long-term mental and physical conditions in low-and middle-income countries: narrative review > Conclusions
“11 Mall et al (2017) Cape Town, South Africa (UMIC)”
§ Integrated care for people with long-term mental and physical conditions in low-and middle-income countries: narrative review > References
“Mall S, Hailemariam M, Selamu M, et al. 'Restoring the person's life': a qualitative study to inform development of care for people with severe mental disorders in rural Ethiopia.”
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
§ Integrated care for people with long-term mental and physical conditions in low-and middle-income countries: narrative review > Conclusions
“1. Anderson et al (2015)”
§ Integrated care for people with long-term mental and physical conditions in low-and middle-income countries: narrative review > References
“Anderson DA, Horton C, O'Toole Ml, Brownson CA, Fazzone P, Fisher EB. Integrating depression care with diabetes care in real-world settings: lessons from the Robert Wood Johnson Foundation Diabetes Initiative. Diabetes Spectr 2007; 20: 10-16.”
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
“Hence a total of 933 papers, chapters and reports were selected for title abstract screening, from which 57 were selected for full-text review.A total of 21 papers (18 research papers and 3 book chapters) were included in the final review (see Web Appendix 4).The inter-rater reliability (kappa) between reviewers was 0.80.The excluded articles (n = 819)”
§ Integrated care for people with long-term mental and physical conditions in low-and middle-income countries: narrative review > Results
Reported 819 · recomputed 876
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
§ Integrated care for people with long-term mental and physical conditions in low-and middle-income countries: narrative review > Study design of reviewed papers
“five in lower-middle income countries (India, Kenya, Brazil, and Costa Rica)”
§ Integrated care for people with long-term mental and physical conditions in low-and middle-income countries: narrative review > Conclusions
“10 Marques (2015) Sao Paul, Brazil (UMIC)”
Rated minor: it would not touch a result — a value no result rests on, a p-value that stays on the same side of the significance level, or a conflict that is clerical, resolved elsewhere in the paper, or outside its own findings.
In the paper
§ Integrated care for people with long-term mental and physical conditions in low-and middle-income countries: narrative review > Conclusions
“Only papers referring to LMICs were included.”
§ Integrated care for people with long-term mental and physical conditions in low-and middle-income countries: narrative review > Conclusions
“1. Anderson et al (2015) Ethnic minority population in the highincome settings”
Citations
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Metadata
- Authors
- Thornicroft, G., Ahuja, S., Barber, S., Chisholm, D., Collins, P. Y., Docrat, S., Fairall, L., Lempp, H., Niaz, U., Ngo, V., Patel, V., Petersen, I., Prince, M., Semrau, M., Unützer, J., Yueqin, H., & Zhang, S.
- Affiliations
- King's College London (GB)
- World Health Organization Regional Office for Europe (DK)
- University of Washington (US)
- University of Cape Town (ZA)
- University of Health Sciences Lahore (PK)
- RAND Corporation (US)
- Harvard University (US)
- University of KwaZulu-Natal (ZA)
- Brighton and Sussex Medical School (GB)
- Peking University Sixth Hospital (CN)
- Corresponding author
- Thornicroft, Graham
- ORCID
- Venue
- The Lancet Psychiatry
- Publisher
- Elsevier BV
- Published
- 2019-02
- Volume
- 6
- Issue
- 2
- Pages
- 174-186
- ISSN
- 2215-0366 (ISSN-L)
- OpenAlex
- W2889176589
- Semantic Scholar
- 4e3cae2bf4758b6c53fa8142aadf9974945a177e
- Cited by
- 138
- References
- 106
- Citations by year
- 2026: 11 · 2025: 16 · 2024: 23 · 2023: 23 · 2022: 21 · 2021: 14 · 2020: 18 · 2019: 11
- FWCI
- 1.71
- Type
- journal article
- Language
- en
- Open access
- green
- kclpure.kcl.ac.uk
- Licence
- Locations
- The Lancet Psychiatry (publishedVersion)
- PubMed (publishedVersion)
- Research Portal (King's College London) (submittedVersion, cc-by-nc-nd)
- Sussex Research Online (University of Sussex) (submittedVersion, cc-by-nc-nd)
- Figshare (submittedVersion, cc-by-nc-nd)
- Funders
- National Institute of Mental Health of the National Institutes of Health (R01MH100470)
- European Union Seventh Framework Programme (FP7/2007–2013)
- UK Medical Research Council in relation to the Emilia (MR/S001255/1)
- Indigo Partnership (MR/R023697/1)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Mental Health Treatment and Access
- Social Sciences › Psychology › Clinical Psychology › Psychiatric care and mental health services
- Health Sciences › Medicine › Epidemiology › Chronic Disease Management Strategies
- Keywords
- integrated care, chronic mental illness, somatic comorbidity, low- and middle-income countries, chronic care, care coordination, implementation barriers, organizational challenges, evidence base, mental health services
- MeSH terms
- Mental Disorders, Chronic Disease, Developing Countries, Humans, Income, Poverty, Primary Health Care, Comorbidity, Delivery of Health Care, Integrated, Disease Management
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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