The role of continuity of care (COC) in the treatment of comorbid mental health and substance use disorders (SUDs): A systematic review of the literature

Abstract

Objective: A systematic review of the literature was conducted, in order to investigate the role of continuity of care (COC) in the treatment of comorbid mental health and substance use disorders (SUDs). Methods: Reviewed databases included: Academic One File, Academic Search Premier, CINAHL, Cochrane, Embase, Eric, Informit, PsychArticles, PsychInfo, Scopus, Web of Science and Google Scholar. Abstracts and titles meeting the following inclusion criteria were included: studies published in English, peer reviewed, published after 1980, DSM-IV or ICD-10 criteria of mental health and SUD and a psychometric measurement of COC. Based on rigorous screening, a total of 45 relevant articles remained for analysis. Results: Majority of relevant articles referred to alcohol use disorder, depression and anxiety disorder comorbidity. Reviewed studies discussed COC in the context of sustained contact, COC through discharge and transfers and as a measure of program quality. In all domains, COC was observed to be lower among patients with mental health and SUD comorbidity, as opposed to patients with a single SUD diagnosis. Conclusions: Relevant studies lacked consideration of significant aspects of COC. These include: COC between service facilities, COC of service provider, meeting individual patient needs and co-ordination of case management teams. These aspects of COC have been shown to be associated with a number of positive treatment outcomes in the treatment of other health related conditions such as cancer and diabetes. More research investigating the effectiveness of interventions targeting these aspects of COC for the treatment of comorbid disorders is required.