Better together? a naturalistic qualitative study of inter-professional working in collaborative care for co-morbid depression and physical health problems

Implementation Science

Peter A Coventry¹  Harish Thampy²  Chris Keyworth¹  Isabel Adeyemi¹  Nia Coupe¹  Carolyn Chew-Graham¹  Sarah E Knowles² 

[1] Greater Manchester Collaboration for Leadership in Applied Health Research and Care, Institute of Population Health and Manchester Academic Health Science Centre, University of Manchester, Manchester, M13 9PL, UK;NIHR School for Primary Care Research, Manchester Academic Health Science Centre, University of Manchester, Manchester, M13 9PL, UK

关键词: Primary care;    Chronic care;    Collaborative care;    Qualitative;    Implementation;    Co-morbidity;    Mental health;    Depression;   

Others  :  813320
DOI  :  10.1186/1748-5908-8-110

 received in 2013-02-06, accepted in 2013-08-07,  发布年份 2013

【 摘 要 】

Background

Mental-physical multi-morbidities pose challenges for primary care services that traditionally focus on single diseases. Collaborative care models encourage inter-professional working to deliver better care for patients with multiple chronic conditions, such as depression and long-term physical health problems. Successive trials from the United States have shown that collaborative care effectively improves depression outcomes, even in people with long-term conditions (LTCs), but little is known about how to implement collaborative care in the United Kingdom. The aim of the study was to explore the extent to which collaborative care was implemented in a naturalistic National Health Service setting.

Methods

A naturalistic pilot study of collaborative care was undertaken in North West England. Primary care mental health professionals from IAPT (Increasing Access to Psychological Therapies) services and general practice nurses were trained to collaboratively identify and manage patients with co-morbid depression and long-term conditions. Qualitative interviews were performed with health professionals at the beginning and end of the pilot phase. Normalization Process Theory guided analysis.

Results

Health professionals adopted limited elements of the collaborative care model in practice. Although benefits of co-location in primary care practices were reported, including reduced stigma of accessing mental health treatment and greater ease of disposal for identified patients, existing norms around the division of mental and physical health work in primary care were maintained, limiting integration of the mental health practitioners into the practice setting. Neither the mental health practitioners nor the practice nurses perceived benefits to joint management of patients.

Conclusions

Established divisions between mental and physical health may pose particular challenges for multi-morbidity service delivery models such as collaborative care. Future work should explore patient perspectives about whether greater inter-professional working enhances experiences of care. The study demonstrates that research into implementation of novel treatments must consider how the introduction of innovation can be balanced with the need for integration into existing practice.

【 授权许可】

   
2013 Knowles et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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