Seminar Details
Speakers: Gritt Overbeck, University of Copenhagen
Date and time: Tuesday 16th February, 1-2pm
Venue: 6th Floor Library, Centre for Primary Care, 6th floor, Williamson Building, The University of Manchester, Oxford Road (Directions)
Booking: No need to book, just turn up.
Background:
Collaborative care is an increasingly popular approach for improving quality of care for people with mental health problems through an intensified and structured collaboration between primary care providers and health professionals with specialized psychiatric expertise. Trials have shown significant positive effects for patients suffering from depression but since collaborative care is a complex intervention, it is important to understand the factors which affect its implementation. We present a qualitative systematic review of the enablers and barriers to implementing collaborative care for patients with anxiety and depression.
Methods:
We developed a comprehensive search strategy in cooperation with a research librarian and performed a search in five databases (EMBASE, PubMed, PsychINFO, ProQuest, and CINAHL). All authors independently screened titles and abstracts and reviewed full-text articles. Studies were included if they were published in English and used original qualitative data on the implementation of a collaborative care intervention targeted at depression or anxiety in an adult patient population in a high-income country. Our subsequent analysis employed a thematic approach based on Normalization Process Theory (NPT).
Results:
We included 17 studies in our review 16 of which were conducted in the USA or the UK. We identified several barriers and enablers within the four major analytical dimensions of NPT. Securing buy-in among primary care providers was found to be critical but sometimes difficult. Enablers included physician champions, reimbursement for extra work, and feedback on the effectiveness of collaborative care. The social and professional skills of the care managers seemed critical for integrating collaborative care in the primary health care clinic. Daily enactment was also found to be facilitated by co-location since this supports regular face-to-face interactions between physicians and care managers.
Conclusions:
The following areas require special attention when planning collaborative care interventions: effective educational programs, especially for care managers; issues of reimbursement in relation to primary care providers; good systems for communication and monitoring; and promoting face-to-face interaction between care managers and physicians, preferably through co-location. There is a need for well-sampled, in-depth qualitative studies on the implementation of collaborative care in countries other than the USA and the UK.