Background
Components of a collaborative care intervention (Gunn et al. 2006)
Collaborative care pilot phase: implementation in a naturalistic setting
Training for health professionals in collaborative care for patients with LTCs
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Understanding LTCs (Diabetes, COPD, CHD)
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Interventions to manage depression, anxiety and LTCs
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Medication management and lifestyle interventions
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Behavioral activation and cognitive interventions for LTCs
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Effective liaison with practice staff
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Talking about anxiety and depression with patients with LTCs
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Formal assessment and screening of anxiety and depression in patients with LTCs
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Low intensity interventions for anxiety and depression – introducing the interventions to patients
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Implementing the care pathway
Theoretical model of implementation: normalization process theory
Methods
Design
Sample
Analysis
NPT Constructs (May and Finch 2009)
Results
Primary thematic analysis at T1: experience of collaborative care
Coming together | Staying apart |
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Organizational facilitators: | Organizational barriers: |
Co-location:
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Lack of integration:
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• Allows informal collaboration: ‘Last week there was a question that I had about somebody’s diabetes and the use of insulin… I actually just popped my head around the door for one of the practice nurses…just being there meant that I could ask her that.’ PWP01 | • Lack of shared resources ; time for appointments not allocated by practice managers, limited access to practice information systems: ‘ ‘They’ve [nurses] got so many other things to factor into their appointments, they forget that I’m there.’ PWP05 |
• Destigmatises access to mental healthcare: ‘It’s based in the surgery…it’s not something strange and new and it works well, being in the same building, definitely, than going somewhere else.’ PN10 | ‘I feel quite blind by not having [access to] that [IT] system.’ PWP04 |
• GPs unaware of or uninvolved with the PWPs: ‘GP’s don’t even, I don’t think they know what the [IAPT] service does, never mind the role of the [PWP] practitioner.’ PWP02 | |
‘GPs… they’re obviously not doing it themselves… They probably haven’t got time, but we haven’t either.’ PN11 | |
Attitudinal Facilitators:
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Attitudinal Barriers:
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Perceived benefit of providing holistic care:
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Role boundaries:
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• Increased co-ordination and continuity of care: ‘Hopefully they’ll [patients] feel that there’s that continuous care kind of thing… they’ll see that it’s sort of a joined up kind of care and that they’re not just put onto another system, and that we’re still all talking to each other.’ PN01 | • Clear division of mental and physical health work and expertise: ‘You’ve kind of got the mental bit which is me and then the physical which is the nurse…’cause I don’t want the patients thinking that I can help them…and it’s trying to be really clear that that’s not my role.’ PWP02 |
• Easier disposal route encourages detection: ‘Already I’m more enthusiastic about talking about [depression] and approaching it… because I feel I have something to give now… so instead of this skirting around the subject that I started off with, I feel I can go there now and talk about it quite happily’ PNO5 | • Joint meetings perceived as unnecessary: ‘The nurse comes in just for the last fifteen minutes, otherwise she’d be bored rigid and she has better things to do than listen to me doing my bit.’ PWP02 |
• Lack of confidence to engage in the other area of work: ‘I feel that they [practice nurses] don’t have enough time to talk to people about their emotional wellbeing, and I think that they worry that if they start talking about it they’ll open Pandora’s Box.’ PWP05 | |
‘I feel a lot more comfortable about doing it and because if people do say anything then I know that I have something I can do about it, can suggest something.’ PN08 |