Managing depression in people with multimorbidity: a qualitative evaluation of an integrated collaborative care model

BMC Family Practice

Research Article

Peter A Coventry¹  Isabel Adeyemi¹  Nia Coupe¹  Sarah E Knowles²  Carolyn Chew-Graham³ 

[1] NIHR Collaboration for Leadership in Applied Health Research and Care Greater Manchester and Manchester Academic Health Science Centre, University of Manchester, M13 9PL, Manchester, UK;NIHR School for Primary Care Research and Manchester Academic Health Science Centre, University of Manchester, M13 9PL, Manchester, UK;Primary Care and Health Sciences, University of Keele, and NIHR Collaboration for Leadership in Applied Health Research and Care West Midlands, ST5 5BG, Keele, UK;

关键词: Depression;    Collaborative care;    Psychological therapy;    Integrated care;   

DOI  :  10.1186/s12875-015-0246-5

 received in 2014-11-12, accepted in 2015-02-20,  发布年份 2015

来源: Springer

【 摘 要 】

BackgroundPatients with comorbid depression and physical health problems have poorer outcomes compared with those with single long term conditions (LTCs), or multiple LTCs without depression. Primary care has traditionally struggled to provide integrated care for this group. Collaborative care can reduce depression in people with LTCs but evidence is largely based on trials conducted in the United States that adopted separate treat to target protocols for physical and mental health. Little is known about whether collaborative care that integrates depression care within the management of LTCs is implementable in UK primary care, and acceptable to patients and health care professionals.MethodsNested interview study within the COINCIDE trial of collaborative care for patients with depression and diabetes/CHD (ISRCTN80309252). The study was conducted in primary care practices in North West England. Professionals delivering the interventions (nurses, GPs and psychological well-being practitioners) and patients in the intervention arm were invited to participate in semi-structured qualitative interviews.ResultsBased on combined thematic analysis of 59 transcripts, we identified two major themes: 1) Integration: patients and professionals valued collaborative ways of working because it enhanced co-ordination of mental and physical health care and provided a sense that patients’ health was being more holistically managed. 2) Division: patients and professionals articulated a preference for therapeutic and spatial separation between mental and physical health. Patients especially valued a separate space outside of their LTC clinic to discuss their emotional health problems.ConclusionThe COINCIDE care model, that sought to integrate depression care within the context of LTC management, achieved service level integration but not therapeutic integration. Patients preferred a protected space to discuss mental health issues, and professionals maintained barriers around physical and mental health expertise. Findings therefore suggest that in the context of mental-physical multimorbidity, collaborative care can facilitate access to depression care in ways that overcome stigma and enhance the confidence of multidisciplinary health teams to work together. However, such care models need to be flexible and patient centred to accommodate the needs of patients for whom their depression may be independent of their LTC.

【 授权许可】

Unknown   
© Knowles et al.; licensee BioMed Central. 2015. 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/4.0), 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.