CoLiPri - Consultation-Liaison Intervention in Primary Care

Project coordinators: Prof. Dr. Birgit Watzke; Dr. Markus Wolf; M.Sc. Mariia Merzhvynska

In Switzerland, the general practitioner (GP) is often the first and only point of contact for people suffering from a mental disorder. According to the concept of the "medical home", the primary care sector plays a key role in the treatment of common mental disorders such as depression or anxiety disorders as GPs are the central decision-makers for diagnosis, therapy and referral to specialised treatment. Studies show, however, that only about one out of three individuals with a mental disorder receives professional treatment in Switzerland. Reasons for this situation are complex and include structural barriers such as limited time and resources at practices, lacking services in rural areas causing wait-lists for specialist treatment, and clinical reasons such as low detection rates in mild to moderate cases, as well as individual barriers on the patients’ side such as stigma, emotional barriers or lack of information about treatment options.

The consultation liaison principle, which is based on a multi-professional network and low-threshold cooperation among specialist disciplines, holds promise to overcome some of these barriers, i.e., to support collaboration and transitions between sectors of care, to ultimately improve pathways of care for patients with common mental disorders.

The project "Consultation-Liaison Intervention in Primary Care" (CoLiPri) aims to develop, implement, and evaluate a novel service for GPs and their patients with common mental disorders at the interface of primary and secondary care. The focus of the new service, which is called "Fachstelle Psychische Gesundheit", is on improved local networking, communication and collaboration among GPs, mental health experts, and others involved in the care of depressive and anxiety patients. The major aim of the service is to support the decision-process at primary care practices, and to increase access to evidence-based individually tailored mental health treatment. The services for GPs include expert consultations, on-demand patient referral for structured diagnostics and/or treatment planning as well as brief psychotherapeutic interventions and triage. The service is affiliated with the Department’s Psychotherapy Outpatient Center at the University of Zurich and represents the core of a complex intervention which also includes the implementation of standardised screening procedures at GP practices and quality circles.

 
CoLiPri is funded by the Swiss Science Foundation (SNF) as part of the National Research Programme 74 "Smarter Healthcare". The effectiveness of the complex intervention will be evaluated in a cluster randomised clinical trial against treatment-as-usual delivered in routine primary care (TAU). Patients at risk for a mental disorder with at least mild symptoms of depression and/or anxiety will be recruited at approx. 40 practices in the greater Zurich area. In addition to the effectiveness, implementation processes and the cost-effectiveness of the complex intervention are examined. In case of positive results, the service might serve as blueprint for other mental health conditions and as a model how to increase inter-professional collaboration and resource allocation for the delivery of better health care.

Project duration: 2018 - 2022

Project funding: Swiss National Science Foundation (SNSF)

Project partners:

• Prof. Dr. Thomas Rosemann, Institute of Primary Care, University of Zurich
• Prof. Dr. Matthias Schwenkglenks, Epidemiology, Biostatistics and Prevention Institute, University of Zurich
• PD Dr. Stephanie Bauer, Research Centre for Psychotherapy, University Hospital Heidelberg
• Zurich Cantonal Association of Psychologists ZüPP
• mediX Zürich