Stepped Care Model in Primary Care (COMET)

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Stepped Care Model in Primary Care (COMET)

Translational mental health strategy

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Translational impact

Care models
Collaborative and Stepped Care in Mental Health by Overcoming Treatment Sector Barriers (COMET)

The COMET-Model is a stepped and collaborative care model for depressive, anxiety, somatoform, and/or alcohol abuse disorders that aims to improve mental health in primary care by overcoming treatment sector barriers. The innovative model integrates four disorders in one model with special attention to the aspect of comorbidity.
Evidence-based clinical guidelines and treatment pathways with options of varying intensity, including low-threshold interventions (e.g., Internet-based interventions) form the clinical and procedural basis.
The COMET-Model is integrated in a 3-year health services research project first implemented in 2017 and funded by the Federal Ministry of Education and Research and carried out within the Hamburg Network for Health Services Research (HAM-NET).

Components

The COMET-Model integrates the following components following the Stepped and Collaborative Care Approach:

  • Collaborative multiprofessional network consisting of general practitioners, psychotherapists, and psychiatrists as well as inpatient or day care facilities
  • Online scheduling platform to enhance referral from primary to specialised care
  • Quarterly network meetings to facilitate information exchange and to train clinical competencies
  • Computer-assisted and guideline-based screening, diagnostic, and treatment decision support
  • New intervention elements with varying intensity and setting including low intensity treatment options (basic psychosocial care, psychoeducation, bibliotherapy and internet-based self-help programs)
  • Low level case-management for severe disorders
  • Regularly symptom-monitoring by care providers

The effectiveness and cost-effectiveness of the COMET- Model is under evaluation in a cluster-randomised controlled effectiveness trial with 570 patients recruited by 40 general practitioner practices and followed with a prospective survey at five time points (baseline, 3, 6, 12, and 24 month). The primary outcome is the change in health-related quality of life from baseline to 6-month follow-up compared to treatment as usual. Secondary outcomes include disorder-specific symptom burden, response, remission, functional quality of life, and other clinical and psychosocial variables.

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