self-management skills of patients and family caregivers (McCorkle et al., 2000) may well be effective.
On-site Collocation and Clinical Integration of Services
Multiple studies of mental health care have found that same-site delivery of mental health and primary care is effective in linking patients to the collocated services (Druss et al., 2001; Samet et al., 2001) and can improve treatment outcomes (Unutzer et al., 2001; Weisner et al., 2001). In a 1995 study of a nationally representative sample of outpatient drug use treatment units, same-site delivery of services was more effective than formal arrangements with external providers, referral agreements, or case management in ensuring that patients would utilize necessary services (a first step in collaborative care) (Friedmann et al., 2000).
Integrating psychosocial health care into medical care settings facilitates patient follow-through on referrals, allows for face-to-face verbal communication in addition to or as an alternative to communicating in writing, and allows for informal sharing of the views of different disciplines and easy exchange of expertise (Pincus, 2003). Studies of care collaboration also have shown that physical proximity of would-be collaborators facilitates collaboration (IOM, 2004).
The opportunities for face-to-face communication provided by collocated services are important because multiple studies have identified effective communication between providers as a key feature of care collaboration (Baggs and Schmitt, 1988; Shortell et al., 1994; Schmitt, 2001). “Effective” communication is described as frequent and timely (Shortell et al., 1994; Gittell et al., 2000),15 and is characterized by discussion with contributions by all parties, active listening, openness, a willingness to consider other ideas and ask for opinions, questioning (Baggs and Schmitt, 1997; Shortell et al., 1994), and the free flow of information among participants. This type of communication is less easily achieved through electronic, mail, and telephone communications. Nonetheless, when physical collocation and integration of services is not feasible, other strategies for linking patients with needed services (e.g., through formal referral arrangements or use of case managers) can be used.
Use of care/system navigators, as well as individual patient advocates, is similar to case management and may also help link patients to needed psychosocial services. Such programs in cancer care were developed initially
15As well as accurate, understandable, and satisfying.