Beyond the limitations of best practices: how logic analysis helped reinterpret dual diagnosis guidelines.
The co-occurrence of mental health and substance use disorders is becoming increasingly recognized as a single problem, and professionals recognize that both should be addressed at the same time. Medical best practices recommend integrated treatment. However, criticisms have arisen, particularly concerning the difficulty of implementing integrated teams in specific health-care contexts and the appropriateness of the proposed model for certain populations. Using logic analysis, we identify the key clinical and organizational factors that contribute to successful implementation. Building on both the professional and organizational literatures on integrated services, we propose a conceptual model that makes it possible to analyze integration processes and places integrated treatment within an interpretative framework. Using this model, it becomes possible to identify key factors necessary to support service integration, and suggest new models of practice adapted to particular contexts.
Brousselle
Astrid
A
Département d'administration de la santé, Groupe de recherche interdisciplinaire en santé, Université de Montréal, Pavillon 1420, boul. du Mont-Royal, Montréal, Québec, Canada H2V 4P3. astrid.brousselle@umontreal.ca
Lamothe
Lise
L
Mercier
Céline
C
Perreault
Michel
M
D019985:Benchmarking; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D017831:Diagnosis, Dual (Psychiatry); D005260:Female; D006801:Humans; D008128:Logic; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D008605:Mental Health Services / Q000458:organization & administration*; D017146:Models, Organizational; D009096:Multi-Institutional Systems / Q000458:organization & administration; D010043:Outcome and Process Assessment, Health Care; D010348:Patient Care Team / Q000458:organization & administration*; D019966:Substance-Related Disorders / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*
J Health Soc Behav. 1969 Mar;10(1):3-15
5776946
J Ment Health Policy Econ. 2003 Jun;6(2):77-87
14578540
Soc Sci Med. 2005 Mar;60(6):1371-83
15626531
Healthc Manage Forum. 1995 Fall;8(3):24-35
10153375
Sante Ment Que. 2002;27(2):180-97
18253638
Health Care Manage Rev. 2001 Winter;26(1):70-84; discussion 87-9
11233356
J Psychiatr Pract. 2005 Sep;11(5):315-39
16184072
Schizophr Bull. 1990;16(1):123-32
2185535
J Subst Abuse Treat. 1997 Mar-Apr;14(2):103-11
9258854
Sante Ment Que. 2002;27(2):54-73
18253632
Sante Ment Que. 2001;26(2):22-46
18253604
Med Care Rev. 1985 Spring;42(1):11-35
10271939
Sante Ment Que. 2002;27(2):74-92
18253633
J Subst Abuse Treat. 2006 Jan;30(1):79-84
16377455
Rev Epidemiol Sante Publique. 2000 Dec;48(6):517-39
11148425
Front Health Serv Manage. 1996 Fall;13(1):3-40; discussion 57-8
10159629
J Healthc Manag. 1999 Jan-Feb;44(1):14-31; discussion 31-3
10345554
Psychiatr Serv. 2001 Apr;52(4):469-76
11274491
Community Ment Health J. 2002 Dec;38(6):507-21
12474938
Health Care Manage Rev. 2003 Jan-Mar;28(1):79-92
12638375