Abstract

MILLAN-GONZALEZ, Ricardo. Implementing the collaborative approach in Costa Rica: Towards an integration between psychiatry and primary care. Acta méd. costarric [online]. 2014, vol.56, n.4, pp.150-157. ISSN 0001-6002.

Introduction: The World Health Organization has established that the treatment gap in mental health can be reduced by investing on primary care. The collaborative approach is a standardized methodology backed by scientific evidence on its effectiveness and cost-effectiveness in these populations. Aim: To discuss the implementation of collaborative care in Costa Rica though a directed literature review and to present a critical appraisal of Costa Rica´s current model. Design: Literature review, analysis of the national model and an implementation proposal. Results: Costa Rica uses the reference model, which has less scientific support than the collaborative one and probably tends to increase the treatment gap. Discussion and recommendations: The collaborative care model would allow greater recognition of psychiatric comorbidity, improve management and treatment techniques, increase the cost-benefit balance, and probably reduce the treatment gap. Conclusions: Most psychiatric resources should be deployed to the primary care level. Collaborative care has been proved to be the best treatment strategy for psychiatric comorbidity in this population. It is possible to establish this approach in Costa Rica because of the wide coverage of primary care. Its implementation should be promoted by the joint action of the Ministry of Health, the Costa Rican Social Security System and medical schools.

Keywords : collaborative approach; primary care; mental health; case manager.

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