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Co-producing Healthcare Interventions: Transforming Transdisciplinary Research to Develop Healthcare Services to Meet the Needs of Patients with Complex Problems

Abstract

Patients with severe mental illness (SMI) and concurrent physical diseases have complex health problems that are often not handled optimally. The treatment and care take place across sector borders and this cross-sectorial cooperation often proves inadequate and deficient in the handling of patients with SMI and multimorbidity. In an on-going study of patients with severe mental illness (SMI) and concurrent physical diseases, a new attempt is being made at using co-production to develop useful and applicable integrated care models. The aim of this study (The Phy-Psy Trial/PPT) is to develop a care model that bridges the gaps between the health care sectors, while at the same time taking into account the perspectives of both the patients and their relatives. The co-production process developed for the PPT is described and discussed in this chapter.

The co-production approach for the PPT takes place on two levels. One is the interdisciplinary research level, where researchers from the different disciplines involved are brought together to develop and exchange knowledge and research results in order to develop an integrated care model to improve the care of people with SMI. The other is the practice level, where groups of actors—patients, professionals, and policy makers—meet to share their viewpoints and knowledge. There have been challenges on both levels. The involved research groups have turned out to work at different paces, meaning that they have to interact much more than anticipated in order to exchange the knowledge and input needed for their work. Also, their different methods and ways of doing research have resulted in complications that have had to be resolved. This has been part of the on-going process, and solutions are continuously being found to the difficulties posed by this large-scale, interdisciplinary collaboration. On the practice level, the participating groups of actors have contributed with valuable information about their experiences in and with the health care system. This knowledge informs the gaps and pitfalls across the sectors of the health care system, which has to be met to be able to target and adjust the new care model, thus making it implementable. This chapter is no recipe for co-production. Rather, it is pointing to possibilities as well as highlighting various challenges that co-producers of interventions for patients with physical and somatic multimorbidity may encounter.

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References

  1. Sturmberg JP, O’Halloran DM, Martin CM. People at the centre of complex adaptive health systems reform. Med J Aust. 2010;193(8):474–8.

    PubMed  Google Scholar 

  2. Searl M, Borgi L, Chemali Z. It is time to talk about people: a human-centered healthcare system. Health Res Policy Syst. 2010;8:35.

    CrossRef  Google Scholar 

  3. Plochg T, Klazinga NS, Starfield B. Transforming medical professionalism to fit changing health needs. BMC Med. 2009;7:64.

    CrossRef  Google Scholar 

  4. Batalden M, Batalden P, Margolis P, Seid M, Armstrong G, Opipari-Arrigan L, Hartung H. Coproduction of healthcare service. BMJ Qual Saf. 2015;25(7):509–17.

    CrossRef  Google Scholar 

  5. Mercer SW, O’Brien R, Fitzpatrick B, Higgins M, Guthrie B, Watt G, Wyke S. The development and optimisation of a primary care-based whole system complex intervention (CARE Plus) for patients with multimorbidity living in areas of high socioeconomic deprivation. Chronic Illn. 2016;12(3):165–81.

    CrossRef  Google Scholar 

  6. Sturmberg JP, O’Halloran DM, Martin CM. Understanding health system reform - a complex adaptive systems perspective. J Eval Clin Pract. 2012;18(1):202–8.

    CrossRef  Google Scholar 

  7. Frodeman R. Sustainable knowledge. A theory of interdisciplinarity. London: Palgrave Macmillan; 2014.

    Google Scholar 

  8. Barnett K, Mercer SW, Norbury M, Watt G, Wyke S, Guthrie B. Epidemiology of multimorbidity and implications for health care, research, and medical education: a cross-sectional study. Lancet 2012;380(9836):37–43.

    CrossRef  Google Scholar 

  9. Willadsen TG, Bebe A, Koster-Rasmussen R, Jarbol DE, Guassora AD, Waldorff FB, Reventlow S, Olivarius Nde F. The role of diseases, risk factors and symptoms in the definition of multimorbidity - a systematic review. Scand J Prim Health Care 2016;34(2):112–21.

    CrossRef  Google Scholar 

  10. Mercer SW, Gunn J, Bower P, Wyke S, Guthrie B. Managing patients with mental and physical multimorbidity. BMJ 2012;345:e5559.

    CrossRef  Google Scholar 

  11. Laursen TM, Nordentoft M, Mortensen PB. Excess early mortality in schizophrenia. Annu Rev Clin Psychol. 2014;10:425–48.

    CrossRef  Google Scholar 

  12. Lawrence D, Hancock KJ, Kisely S. The gap in life expectancy from preventable physical illness in psychiatric patients in Western Australia: retrospective analysis of population based registers. BMJ 2013;346:f2539.

    CrossRef  Google Scholar 

  13. De Hert M, Cohen D, Bobes J, Cetkovich-Bakmas M, Leucht S, Ndetei DM, Newcomer JW, Uwakwe R, Asai I, Möller HJ, Gautam S, Detraux J, Correll CU. Physical illness in patients with severe mental disorders. II. Barriers to care, monitoring and treatment guidelines, plus recommendations at the system and individual level. World Psychiatry 2011;10(2):138–51.

    CrossRef  Google Scholar 

  14. Coventry PA, Small N, Panagioti M, Adeyemi I, Bee P. Living with complexity; marshaling resources: a systematic review and qualitative meta-synthesis of lived experience of mental and physical multimorbidity. BMC Fam Pract. 2015;16:171.

    CrossRef  Google Scholar 

  15. Smith SM, Bayliss EA, Mercer SW, Gunn J, Vestergaard M, Wyke S, Salisbury C, Fortin M. How to design and evaluate interventions to improve outcomes for patients with multimorbidity. J Comorb. 2013;3(1):8.

    CrossRef  Google Scholar 

  16. Wallace E, Salisbury C, Guthrie B, Lewis C, Fahey T, Smith SM. Managing patients with multimorbidity in primary care. BMJ 2015;350:h176.

    CrossRef  Google Scholar 

  17. Sturmberg JP, Martin C, Katerndahl DA. Systems and complexity thinking in the general practice literature: an integrative, historical narrative review. Ann Fam Med. 2014;12(1):66–74.

    CrossRef  Google Scholar 

  18. Rosbach M, Andersen JA. Patient-experienced burden of treatment in patients with multimorbidity - a systematic review of qualitative data. PLoS One. 2017;12(6):e0179916.

    CrossRef  Google Scholar 

  19. Demain S, Gonçalves A-C, Areia C, Oliveira R, Marcos AJ, Marques A, Parmar R, Hunt K. Living with, managing and minimising treatment burden in long term conditions: a systematic review of qualitative research. PLoS One. 2015;10(5):e0125457.

    CrossRef  Google Scholar 

  20. May CR, Eton DT, Boehmer K, Gallacher K, Hunt K, MacDonald S, Mair FS, May CM, Montori VM, Richardson A, Rogers AE, Shippee N. Rethinking the patient: using Burden of Treatment Theory to understand the changing dynamics of illness. BMC Health Serv Res. 2014;14:281.

    CrossRef  Google Scholar 

  21. Speyer H, Christian Brix Nørgaard H, Birk M, Karlsen M, Storch Jakobsen A, Pedersen K, Hjorthøj C, Pisinger C, Gluud C, Mors O, Krogh J, Nordentoft M. The CHANGE trial: no superiority of lifestyle coaching plus care coordination plus treatment as usual compared to treatment as usual alone in reducing risk of cardiovascular disease in adults with schizophrenia spectrum disorders and abdominal obesity. World Psychiatry 2016;15(2):155–65.

    CrossRef  Google Scholar 

  22. Reeve J, Blakeman T, Freeman GK, Green LA, James PA, Lucassen P, Martin CM, Sturmberg JP, Weel C van. Generalist solutions to complex problems: generating practice-based evidence - the example of managing multi-morbidity. BMC Fam Pract. 2013;14:112.

    PubMed  Google Scholar 

  23. Coulter A. Patient engagement–what works? J Ambul Care Manage. 2012;35(2):80–9.

    CrossRef  Google Scholar 

  24. Sturmberg JP, Njoroge A. People-centred health systems, a bottom-up approach: where theory meets empery. Journal Eval Clin Pract. 2017;23(2):467–73.

    CrossRef  Google Scholar 

  25. Larsen JR, Siersma VD, Davidsen AS, Waldorff FB, Reventlow S, de Fine Olivarius N. The excess mortality of patients with diabetes and concurrent psychiatric illness is markedly reduced by structured personal diabetes care: a 19-year follow up of the randomized controlled study Diabetes Care in General Practice (DCGP). Gen Hosp Psychiatry 2016;38:42–52.

    CrossRef  Google Scholar 

  26. de Fine Olivarius N, Beck-Nielsen H, Andreasen AH, Hørder M, Pedersen PA. Randomised controlled trial of structured personal care of type 2 diabetes mellitus. BMJ 2001;323:970–5.

    CrossRef  Google Scholar 

  27. Shippee ND, Shah ND, May CR, Mair FS, Montori VM. Cumulative complexity: a functional, patient-centered model of patient complexity can improve research and practice. J Clin Epidemiol. 2012;65(10):1041–51.

    CrossRef  Google Scholar 

  28. Rodgers M. Dalton J, Harden M, Street A, Parker G, Eastwood A. Integrated care to address the physical health needs of people with severe mental illness: a mapping review of the recent evidence on barriers, facilitators and evaluations. Int J Integrated Care 2018;18(1):9.

    CrossRef  Google Scholar 

  29. Coulter A, Collins A. Making shared decision-making a reality. No decision about me, without me. London: Kings Fund; 2011.

    Google Scholar 

  30. Gillard S, Simons L, Turner K, Lucock M, Edwards C. Patient and public involvement in the coproduction of knowledge reflection on the analysis of qualitative data in a mental health study. Qual Health Res. 2012;22(8):1126–37.

    CrossRef  Google Scholar 

  31. Jønsson ABR, Guassora AD, Freil M, Reventlow S. Patient knowledge. What the doctor doesn’t know: discarded patient knowledge of older adults with multimorbidity. Chronic Illn. 2018; [E-pub ahead of print] https://doi.org/10.1177/1742395318796173.

  32. Long JC, Cunningham FC, Braithwaite J. Bridges, brokers and boundary spanners in collaborative networks: a systematic review. BMC Health Serv Res. 2013;13:158.

    CrossRef  Google Scholar 

  33. Hunt CM, Spence M, McBride A. The role of boundary spanners in delivering collaborative care: a process evaluation. BMC Fam Pract. 2016;17:96–105.

    CrossRef  Google Scholar 

  34. Grimshaw JM, Shirran L, Thomas R, Mowatt G, Fraser C, Bero L, Grilli R, Harvey E, Oxman A, O’Brien MA. Changing provider behavior: an overview of systematic reviews of interventions. Med Care 2001;39(8 Suppl 2):II2–45.

    CAS  PubMed  Google Scholar 

  35. Timmermans S, Berg M. The practice of medical technology. Sociol Health Illn. 2003; 25(3):97–114.

    CrossRef  Google Scholar 

  36. Craig P, Dieppe P, Macintyre S, Michie S, Nazareth I, Petticrew M. Developing and evaluating complex interventions: the new Medical Research Council guidance. BMJ 2008;337:a1655.

    CrossRef  Google Scholar 

  37. May C. A rational model for assessing and evaluating complex interventions in health care. BMC Health Serv Res. 2006;7(6):86.

    CrossRef  Google Scholar 

  38. Roberts G, Cornwell J, Locock L, Purushotham A, Sturmey G, Gager M. Patients and staff as codesigners of healthcare services. BMJ 2015;350:g7714.

    CrossRef  Google Scholar 

  39. Domecq JP, Prutsky G, Elraiyah T, Wang Z, Nabhan M, Shippee N, Brito JP, Boehmer K, Hasan R, Firwana B, Erwin P, Eton D, Sloan J, Montori V, Asi N, Dabrh AM, Murad MH. Patient engagement in research: a systematic review. BMC Health Serv Res. 2014;14:89.

    CrossRef  Google Scholar 

  40. Rowe J. Great expectations: a systematic review of the literature on the role of family carers in severe mental illness, and their relationships and engagement with professionals. J Psychiatr Ment Health Nurs. 2012;19(1):70–82.

    CAS  CrossRef  Google Scholar 

  41. Malterud K, Elbakken KT. Patients participating as co-researchers in health research: a systematic review of outcomes and experiences. 2019:(Forthcoming)

    Google Scholar 

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Reventlow, S., Jønsson, A.B.R., Møller, M.C.R., Davidsen, A.S., Olsen, L. (2019). Co-producing Healthcare Interventions: Transforming Transdisciplinary Research to Develop Healthcare Services to Meet the Needs of Patients with Complex Problems. In: Sturmberg, J. (eds) Embracing Complexity in Health. Springer, Cham. https://doi.org/10.1007/978-3-030-10940-0_10

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