Facilitating professional liaison in collaborative care for depression in UK primary care; a qualitative study utilising normalisation process theory

BMC Family Practice

Commentary

Nia Coupe¹  Linda Gask¹  Paul Sykes¹  Carolyn Chew-Graham²  Emma Anderson³  David A Richards⁴ 

[1] Centre for Primary Care, Institute of Population Health, Williamson Building, Oxford Road, University of Manchester, M13 9PL, Manchester, UK;Centre for Primary Care, Institute of Population Health, Williamson Building, Oxford Road, University of Manchester, M13 9PL, Manchester, UK;Primary Care and Health Sciences, Keele University, ST5 5BG, Staffordshire, UK;School of Experimental Psychology, University of Bristol, BS8 1TU, Bristol, UK;University of Exeter Medical School, Haighton Building, St Luke’s Campus, Heavitree Road, EX1 2 LU, Exeter, UK;

关键词: Collective Action;    Behavioural Activation;    Collaborative Care;    Collaborative Approach;    Mental Health Worker;   

DOI  :  10.1186/1471-2296-15-78

 received in 2013-09-30, accepted in 2014-03-21,  发布年份 2014

来源: Springer

【 摘 要 】

BackgroundCollaborative care (CC) is an organisational framework which facilitates the delivery of a mental health intervention to patients by case managers in collaboration with more senior health professionals (supervisors and GPs), and is effective for the management of depression in primary care. However, there remains limited evidence on how to successfully implement this collaborative approach in UK primary care. This study aimed to explore to what extent CC impacts on professional working relationships, and if CC for depression could be implemented as routine in the primary care setting.MethodsThis qualitative study explored perspectives of the 6 case managers (CMs), 5 supervisors (trial research team members) and 15 general practitioners (GPs) from practices participating in a randomised controlled trial of CC for depression. Interviews were transcribed verbatim and data was analysed using a two-step approach using an initial thematic analysis, and a secondary analysis using the Normalisation Process Theory concepts of coherence, cognitive participation, collective action and reflexive monitoring with respect to the implementation of CC in primary care.ResultsSupervisors and CMs demonstrated coherence in their understanding of CC, and consequently reported good levels of cognitive participation and collective action regarding delivering and supervising the intervention. GPs interviewed showed limited understanding of the CC framework, and reported limited collaboration with CMs: barriers to collaboration were identified. All participants identified the potential or experienced benefits of a collaborative approach to depression management and were able to discuss ways in which collaboration can be facilitated.ConclusionPrimary care professionals in this study valued the potential for collaboration, but GPs’ understanding of CC and organisational barriers hindered opportunities for communication. Further work is needed to address these organisational barriers in order to facilitate collaboration around individual patients with depression, including shared IT systems, facilitating opportunities for informal discussion and building in formal collaboration into the CC framework.Trial registrationISRCTN32829227 30/9/2008.

【 授权许可】

Unknown   
© Coupe et al.; licensee BioMed Central Ltd. 2014. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.