Supporting the Integrated Management of Multi-morbidity (SIMM)

Lead: Scott Weich 

Project manager: Emily Wood (e.f.wood@sheffield.ac.uk) 

The SIMM study is addressing the implementation challenges of integrated care for patients with both a long term physical condition and depression. It is hosted by the School of Health and Related Research at the University of Sheffield[U1] .

The first part of the study is researching any disparity that may occur in accessing psychological therapy for depression when the patient also has a long term physical health condition. Information collected routinely by Sheffield General Practitioners (GPs) about primary and hospital care will be combined with information collected by the Sheffield Improving Access to Psychological Therapies (IAPT) service. The GP information will enable the research team to identify the numbers of people across the city with depression and long term conditions. Then data for all patients identified as having depression will be accessed and this data will be matched to the IAPT database.

The purpose is to see if people with depression and a long term condition receive different services to those who have depression but no other long term condition. This will include if there is a difference in rates of referral to IAPT, the amount of sessions in IAPT, clinical outcomes from IAPT, and also the utilisation of general hospital services such as A&E attendance and unplanned admissions. We will also see if the GP practice a person attends or if the level of deprivation a person faces makes a difference to their treatment.

Results from this part of the study will then feed into further research aiming to improve access to, and acceptability of, treatment for depression in patients with long term conditions.  

We have conducted a systematic review [U2] of the research literature to investigate the barriers and facilitators to integrated care for people who have depression and a co-morbid long-term physical condition. The purpose was to learn from the experiences of those who have researched the implementation of integrated care and to draw those lessons together. We will use this information to develop a way of overcoming these barriers and allowing the successful implementation of integrated care.

The final stage of this research project will be to implement this approach to integrated care and evaluate its success in improving access to treatment, and the success rate of that treatment, for people with depression and long term physical health conditions.



Sheffield Physical Health and Psychological Wellbeing (IAPT Project): Phase Two Implementation Evaluation Project

Lead: Moira Leahy (moira.leahy@shsc.nhs.uk)

Collaborators: Thomas Ricketts, Steve Kellett, Steve Haigh, Paula Crosby, Toni Mank, Michael Barkham, Caroline Mitchell, Rachel Smith, Wesley Vernon, Jo Cooke, Rachel Warner, Fiona Goudie, Deborah Gamsu

 

Training physical health practitioners in mental health skills is a national priority  identified in Closing the Gap (2013). IAPT is a national NHS programme rolling out services across England offering NICE approved interventions for people with anxiety and depression. Extending access to IAPT services is a local, regional and national priority.  There is increasing recognition of the need to challenge the historical split between physical and mental health services, if truly holistic, person-centred care is to be delivered.

 

Sheffield is the site of a ground breaking Yorkshire and Humber Health Education (LETB) regional project testing an innovative way of integrating the delivery of physical health and mental health services. We are doing this by seconding physical health practitioners to undertake the training and qualify as IAPT Psychological Well Being Practitioners (PWPs).

The project is working under the umbrella of Sheffield Right First Time.

 

Project Aims:

1.      To test whether this model improves access to talking therapies for people with physical health problems who also have common mental health problems

2.      To explore the contribution of IAPT PWP intervention skills to the facilitation of self-management in people with long term conditions/physical health problems

3.     To assess the implications of dual training practitioners for pre and post registration training going forward.

 

Phase One: October 2012 to September 2014

By September 2014, we have twelve dual trained practitioners. Our project experience thus far has indicated that equipping physical health practitioners with IAPT PWP skills has huge potential to deliver truly integrated and holistic interventions that improve patient experience and outcomes; increase detection of and access to treatment for common mental health problems; increase engagement and support people to self-manage their health condition; make cost savings; and enhance practitioner satisfaction.

 

Phase Two: October 2014 – March 2015

To enable and support dual trained practitioners to test out delivery of integrated, holistic health care. (NB. Where possible, integrated delivery is being tested within core physical health roles and seconding teams. Where necessary, testing is being undertaken via protected, backfilled time). 

 

Design and methodology

A mixed method approach will be taken to evaluation that enables identification of processes and outcomes related to the initiative. This approach will include the following elements:

  • ·         Capturing dual trained practitioner learning and experience
  • ·         Stakeholder feedback
  • ·         Audit of patient reported outcomes and experiences