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BMC Primary Care
Published in: BMC Primary Care 1/2018

Open Access 01-12-2018 | Research article

Who needs collaborative care treatment? A qualitative study exploring attitudes towards and experiences with mental healthcare among general practitioners and care managers

Authors: Marlene Christina Rosengaard Møller, Anna Mygind, Flemming Bro

Published in: BMC Primary Care | Issue 1/2018

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Abstract

Background

Collaborative care treatment is widely recognized as an effective approach to improve the quality of mental healthcare through enhanced and structured collaboration between general practice and specialized psychiatry. However, studies indicate that the complexity of collaborative care treatment interventions challenge the implementation in real-life general practice settings. Four Danish Collaborative Care Models were launched in 2014 for patients with mild/moderate anxiety and depression. These involved collaboration between general practitioners, care managers and consultant psychiatrists.
Taking a multi-practice bottom-up approach, this paper aims to explore the perceived barriers and enablers related to collaborative care for patients with mental health problems and to investigate the actual experiences with a Danish collaborative care model in a single-case study in order to identify enablers and barriers for successful implementation.

Methods

Combining interviews and observations of usual treatment practices, we conducted a multi-practice study among general practitioners who were not involved in the Danish collaborative care models to explore their perspectives on existing mental health treatment and to investigate (from a bottom-up approach) their perceptions of and need for collaborative care in mental health treatment. Additionally, by combining observations and qualitative interviews, we followed the implementation of a Danish collaborative care model in a single-case study to convey identified barriers and enablers of the collaborative care model.

Results

Experienced and perceived enablers of the Danish collaborative care model mainly consisted of a need for new treatment options to deal with mild/moderate anxiety and depression. The model was considered to meet the need for a free fast track to high-quality treatment. Experienced barriers included: poor adaptation of the model to the working conditions and needs in daily general practice, time consumption, unsustainable logistical set-up and unclear care manager role. General practitioners in the multi-practice study considered access to treatment and not collaboration with specialised psychiatry to be essential for this group of patients.

Conclusions

The study calls for increased attention to implementation processes and better adaptation of collaborative care models to the clinical reality of general practice. Future interventions should address the treatment needs of specific patient populations and should involve relevant stakeholders in the design and implementation processes.
Appendix
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Literature
1.
van der Feltz-Cornelis CM. Ten years of integrated care for mental disorders in the Netherlands. Int J Integr Care 2011;11 Spec Ed:e015.
2.
Huijbregts KM, de Jong FJ, van Marwijk HW, Beekman AT, Ader HJ, Hakkaart-van Roijen L, et al. A target-driven collaborative care model for major depressive disorder is effective in primary care in the Netherlands. A randomized clinical trial from the depression initiative. J Affect Disord. 2013;146(3):328–37.CrossRefPubMed
3.
Muntingh A, van der Feltz-Cornelis C, van Marwijk H, Spinhoven P, Assendelft W, de Waal M, et al. effectiveness of collaborative stepped care for anxiety disorders in primary care: a pragmatic cluster randomised controlled trial. Psychother Psychosom 2014;83(1):37–44.
4.
Coupe N, Anderson E, Gask L, Sykes P, Richards DA, Chew-Graham C. Facilitating professional liaison in collaborative care for depression in UK primary care; a qualitative study utilising normalisation process theory. BMC Fam Pract. 2014;15:78.CrossRefPubMedPubMedCentral
5.
Barley EA, Haddad M, Simmonds R, Fortune Z, Walters P, Murray J, et al. The UPBEAT depression and coronary heart disease programme: using the UK Medical Research Council framework to design a nurse-led complex intervention for use in primary care. BMC Fam Pract. 2012;13:119.CrossRefPubMedPubMedCentral
6.
Katon WJ, Lin EH, Von Korff M, Ciechanowski P, Ludman EJ, Young B, et al. Collaborative care for patients with depression and chronic illnesses. N Engl J Med. 2010;363(27):2611–20.CrossRefPubMedPubMedCentral
7.
Solberg LI, Crain AL, Jaeckels N, Ohnsorg KA, Margolis KL, Beck A, et al. The DIAMOND initiative: implementing collaborative care for depression in 75 primary care clinics. Implement Sci. 2013;8:135.CrossRefPubMedPubMedCentral
8.
Byng R, Norman I, Redfern S, Jones R. Exposing the key functions of a complex intervention for shared care in mental health: case study of a process evaluation. BMC Health Serv Res. 2008;8:274.CrossRefPubMedPubMedCentral
9.
Chwastiak L, Vanderlip E, Katon W. Treating complexity: collaborative care for multiple chronic conditions. Int Rev Psychiatry. 2014;26(6):638–47.CrossRefPubMed
10.
Archer J, Bower P, Gilbody S, Lovell K, Richards D, Gask L, et al. Collaborative care for depression and anxiety problems (review). Cochrane Database Syst Rev. 2012;10:CD006525.PubMed
11.
Whitebird RR, Margolis KL, Asche SE, Trangle MA, Wineman AP. Barriers to improving general practice of depression. Perspectives of medical group leaders. Qual Health Res. 2013;23(6):805.CrossRefPubMed
12.
Knowles SE, Chew-Graham C, Coupe N, Adeyemi I, Keyworth C, Thampy H, et al. Better together? A naturalistic qualitative study of inter-professional working in collaborative care for co-morbid depression and physical health problems. Implement Sci. 2013;8:110.CrossRefPubMedPubMedCentral
13.
Knowles SE, Chew-Graham C, Adeyemi I, Coupe N, Coventry PA. Managing depression in people with multimorbidity: a qualitative evaluation of an integrated collaborative care model. BMC Fam Pract. 2015;16:32.CrossRefPubMedPubMedCentral
14.
Hermens ML, Muntingh A, Franx G, van Splunteren PT, Nuyen J. Stepped care for depression is easy to recommend, but harder to implement: results of an explorative study within primary care in the Netherlands. BMC Fam Pract. 2014;15:5.CrossRefPubMedPubMedCentral
15.
16.
Overbeck G, Davidsen AS, Kousgaard MB. Enablers and barriers to implementing collaborative care for anxiety and depression: a systematic qualitative review. Implement Sci. 2016;11(1):165.CrossRefPubMedPubMedCentral
17.
Katon W, Unutzer J. Collaborative care models for depression: time to move from evidence to practice. Arch Intern Med. 2006;166(21):2304–6.CrossRefPubMed
18.
Eplov LF, Lundsteen M, Birket-Smith M. Shared care for ikke-psykotiske sygdomme. Anbefalinger på baggrund af en systematisk litteraturundersøgelse [Shared care for non-psychotic mental illness. Recommendations based on a systematic review. In Danish]. Danish regions. 2009.
19.
Richards DA, Hill JJ, Gask L, Lovell K, Chew-Graham C, Bower P, et al. Clinical effectiveness of collaborative care for depression in UK primary care (CADET): cluster randomised controlled trial. BMJ. 2013;347:f4913.CrossRefPubMedPubMedCentral
20.
Brinck-Claussen UO, Curth NK, Davidsen AS, Mikkelsen JH, Lau ME, Lundsteen M, et al. Collaborative care for depression in general practice: study protocol for a randomised controlled trial. Trials. 2017;18(1):344.CrossRefPubMedPubMedCentral
21.
Curth NK, Brinck-Claussen UO, Davidsen AS, Lau ME, Lundsteen M, Mikkelsen JH, et al. Collaborative care for panic disorder, generalised anxiety disorder and social phobia in general practice: study protocol for three cluster-randomised, superiority trials. Trials. 2017;18(1):382.CrossRefPubMedPubMedCentral
22.
Gask L, Bower P, Lovell K, Escott D, Archer J, Gilbody S, et al. What work has to be done to implement collaborative care for depression? Process evaluation of a trial utilizing the normalization process model. Implement Sci. 2010;5:15.CrossRefPubMedPubMedCentral
23.
24.
Pedersen KM, Andersen JS, Sondergaard J. General practice and primary health care in Denmark. J Am Board Fam Med. 2012;25(Suppl 1):S34–8.CrossRefPubMed
25.
Bernard HR. Research methods in anthropology. Qualitative and quantitative approaches. Thousand Oaks: Sage; 1994.
26.
Hammersley M, Ethnography AP. Principles in practice. New York: Routledge; 1995.
27.
28.
29.
De Certeau M. The practice of everyday life. Berkeley: University of California Press; 1988.
30.
Jöhncke S, Svendsen MN, Whyte SR. Sociale teknologier som antropologisk arbejdsfelt [Social technologies as field of interest in anthropology. In Danish]. In: Hastrup K, editor. Viden om verden. En grundbog i antropologisk analyse [Knowledge about the world. A guide to anthropological analysis. In Danish]. Copenhagen: Hans Reitzels Forlag; 2004. p. 385–408.
31.
Marshall M, de Silva D, Cruickshank L, Shand J, Wei L, Anderson J. What we know about designing an effective improvement intervention (but too often fail to put into practice). BMJ Qual Saf. 2017;26(7):578–82.CrossRefPubMed
32.
33.
Craig P, Dieppe P, Macintyre S, Michie S, Nazareth I, Petticrew M. Developing and evaluating complex interventions: the new Medical Research Council guidance. BMJ. 2008;337:a1655.CrossRefPubMedPubMedCentral
34.
Moore GF, Audrey S, Barker M, Bond L, Bonell C, Hardeman W, et al. Process evaluation of complex interventions: Medical Research Council guidance. BMJ. 2015;350:h1258.CrossRefPubMedPubMedCentral
35.
Eghaneyan BH, Sanchez K, Mitschke DB. Implementation of a collaborative care model for the treatment of depression and anxiety in a community health center: results from a qualitative case study. J Multidiscip Healthc. 2014;7:503–13.PubMedPubMedCentral
36.
Speyer H, Christian Brix Norgaard H, Birk M, Karlsen M, Storch Jakobsen A, Pedersen K, et al. The CHANGE trial: no superiority of lifestyle coaching plus care coordination plus treatment as usual compared to treatment as usual alone in reducing risk of cardiovascular disease in adults with schizophrenia spectrum disorders and abdominal obesity. World Psychiatry. 2016;15(2):155–65.CrossRefPubMedPubMedCentral
37.
Katon W. Collaborative depression care models: from development to dissemination. Am J Prev Med. 2012;42(5):550–2.CrossRefPubMed
Metadata
Title
Who needs collaborative care treatment? A qualitative study exploring attitudes towards and experiences with mental healthcare among general practitioners and care managers
Authors
Marlene Christina Rosengaard Møller
Anna Mygind
Flemming Bro
Publication date
01-12-2018
Publisher
BioMed Central
Published in
BMC Primary Care / Issue 1/2018
Electronic ISSN: 2731-4553
DOI
https://doi.org/10.1186/s12875-018-0764-z

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