Table 1 Classification of the linkages found in the review
From: Effectiveness of service linkages in primary mental health care: a narrative review part 1
Broad linkage category | Linkage | Definition |
|---|---|---|
Direct collaborative activities | Link working | Organisational tasks connecting 2+ services - may involve limited clinical intervention but not expert clinical advice or structured liaison- does not include the work of an existing employed practice nurse undertaking extended tasks if there is no linkage work outside current general practice. Includes a process to clarify role between LW and others. |
| Â | Co-location | Face-to-face not virtual co-location- could lead to improved practitioner communication. Also includes MH worker (nurse, psychologist) located in primary care practice. Must be providing treatment, not simply an administrative arrangement. |
| Â | Consultation liaison | A practitioner connection where P1 has an explicit arrangement to provide expert level advice about ongoing care to P2 that is apart from the usual referral relationship - it may involve P1 receiving referral letters, making an assessment & providing some treatment and ongoing expert support to P2. Includes the specialists' advice to the primary care practitioner regarding treatment and monitoring (either directly or via another worker e.g., through link working) and may include educative roles. It does not involve the transfer of the patient from primary care. |
| Â | Care management | The coordination of care - it can include assessment, review and follow-up and a care management plan - linking with other services, or defined care pathway. |
Agreed guidelines | Specific treatment protocols | An agreed process that is structured and documented about a specific patient treatment including evidence based algorithms such as in pharmacotherapy or Problem Solving Therapy in Primary Care (PST-PC). Does not include referral, stepped care or care management plan that are coded elsewhere. |
| Â | Stepped care | A treatment trajectory based on patient response or outcome. Involves a formal treatment escalation or de-escalation procedure to involve other providers based on specified patient outcomes. |
Communication systems | Enhanced communication | A formal process with feedback -includes meetings, shared medical records, patient held records, consistent process for notifications, standardised letters, referrals and reports. May includes a worker from outside the practice attending the practice - e.g. to attend meetings. |
| Â | Enhanced referral | Expedited access, explicit referral criteria &/or process, which can include process for emergencies. |
| Â | Electronic communication system | Telephone or video communication between 2+ people with at least 2 practitioners not in same room - may or may not include patients. Includes 'telemedicine'. |
Service agreement | Service or formal work agreement | Formalised contract or funding mechanism about how services will work together. |