title: Continuity across inpatient and outpatient mental health care or specialisation of teams? A systematic review.
abstract: BACKGROUND
  A central question for the organisation of mental health care is whether the same clinicians should be responsible for a patient's care across inpatient and outpatient settings (continuity of care) or if there should be separate teams (specialisation). Current reforms in Europe are inconsistent on which to favour, and are based on little research evidence. This review is the first systematic appraisal of the existing evidence comparing continuity of care and specialisation across inpatient and outpatient mental health care.
  
  
  METHODS
  A systematic search for studies of any design comparing mental health care systems based on continuity or specialisation of care was performed. Differences in clinical, social and cost-effective outcomes, and the views and experiences of patients and staff were assessed using narrative synthesis.
  
  
  RESULTS
  Seventeen studies met the inclusion criteria. All studies had methodological shortcomings, but findings point towards reduced length and number of hospitalisations, and faster or more flexible transitions between services in continuity systems. Survey and qualitative findings suggest advantages of both systems, whilst patients and staff appear to prefer a continuity system.
  
  
  CONCLUSIONS
  The evidence base suggests better outcomes and stakeholder preferences for continuity of care systems, but the quality of existing studies is insufficient to draw definitive conclusions. Higher quality comparative studies across various settings and population groups are urgently needed.
authors.affiliation: Unit for Social and Community Psychiatry (WHO Collaborating Centre for Mental Health Service Development), Queen Mary University of London, London, United Kingdom.
authors.forename: S
authors.initials: S
authors.lastname: Omer
authors.affiliation: Unit for Social and Community Psychiatry (WHO Collaborating Centre for Mental Health Service Development), Queen Mary University of London, London, United Kingdom.
authors.forename: S
authors.initials: S
authors.lastname: Priebe
authors.affiliation: Unit for Social and Community Psychiatry (WHO Collaborating Centre for Mental Health Service Development), Queen Mary University of London, London, United Kingdom. Electronic address: d.giacco@qmul.ac.uk.
authors.forename: D
authors.initials: D
authors.lastname: Giacco
mesh_terms: D003266:Continuity of Patient Care; D003362:Cost-Benefit Analysis; D005060:Europe; D019317:Evidence-Based Medicine; D006302:Health Services Research; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data; D006801:Humans; D007297:Inpatients; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D001523:Mental Disorders / Q000175:diagnosis / Q000628:therapy*; D008605:Mental Health Services / Q000458:organization & administration*; D033262:Narration; D010045:Outpatients; D010348:Patient Care Team; D058028:Research Report / Q000592:standards; D013038:Specialization
keywords: Functional; Integrated; Mental health services; Organisation; Policy; Psychiatry