Background
Methods
Search strategy and sources
Study selection
Inclusion and exclusion criteria
Quality assessment
Data extraction
Synthesis of results
Results
Study selection
Study characteristics
Author, name of intervention study, country | Disease | Aim of study | Data collection methods | Respondents | Data analysis/theoretical framework |
---|---|---|---|---|---|
Gask et al. [42], CADET, UK | Depression | To explore the work that “needs to be done to make a collaborative care intervention for depression in primary care both workable and integrated into routine practice” | Focus groups, one-to-one interviews | 49: 12 PCPs 4 Clinical psychologists 4 Practice nurses 4 Psychiatrists 14 Mental health workers 11 patients | Normalization process model (NPM) |
Coupe et al. [9], CADET, UK | Depression | “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.” “To identify barriers and facilitators to the successful implementation of CC” | Face-to-face interviews with CM and managers Telephone interviews with GPs | 26: 6 CMs, 5 Supervisors from research team, 15 GPs | Thematic analysis and theory-driven analysis using normalization process theory (NPT) |
Knowles et al. [37], COINSIDE, UK | Depression and long-term conditions | To explore (a) the extent to which “collaborative care principles and modes of working were implemented in routine care…” and to (b) “Employ NPT as a conceptual model to identify barriers and facilitators to the adoption and integration of collaborative care…” | Face-to-face semi-structured interviews | 23: 6 Case managers 17 Practice nurses | Thematic analysis and normalization process theory (NPT) |
Knowles et al. [6], COINSIDE, UK | Depression and long-term conditions | “…to examine: a) How the collaborative care model was implemented by usual care providers in a UK setting. b) How patients and providers understood and experienced the integration of mental and physical health care.” | Semi-structured interviews | 61: 11 PWPs 12 PNs, 7 GPs 31 Patients | The constant comparative method |
Byng et al. [33], The Mental Health Link intervention (MHL), UK | Patients with long-term mental illness | To investigate how the MHL intervention “had its effects and how the process evaluation adds meaning to the results of the trial.” | Individual and group interviews | 49: 21 GPs, 8 Community mental health workers, 7 Practice managers, 4 Mental health managers, 3 Practice nurses, 2 Psychiatrists, 1 Practice counselor 1 Facilitator | Case study using the realistic evaluation framework |
Curran et al. [32], CALM, USA | Anxiety | To identify the facilitators and barriers to implement and sustain CALM | Qualitative interviews | 61: 14 Anxiety clinic specialists (ACS) 13 Primary care nurses 18 Primary care administrators 16 Primary care clinic administrators | Content analysis. Coding in three levels: 1: macro themes identified, 2: subcoding identifying barriers and facilitators, 3: interpretation |
Eghaneyan et al. [34], (Collaborative care in a community health center), USA | Depression, anxiety (in a low-income, uninsured Latino population) | “To examine the implementation of a collaborative care model…” and “to identify perceived barriers…” | Semi-structured interviews | 7: 1 Care manager 3 PCPs 1 Nursing director 1 Project manager 1 CEO | Grounded theory approach. Two-leveled coding |
Whitebird et al. [40], DIAMOND, USA | Depression | To identify the care model factors that were key for successful implementation of collaborative depression care | Mixed methods study: Group interviews plus “quantitative measures of patient activation and 6-month remission rates” | 42 Clinics. The exact number of respondents is not stated. Present at the interviews were as follows: “…the project lead, care manager and PCP champion. Other staff encouraged to attend were other physicians, the consulting psychiatrist, and the quality improvement lead” | “Following each site visit, ICSI staff completed a structured qualitative narrative to document their assessment of factors affecting implementation […] Summaries were then prepared by the ICSI site-visit teams and were reviewed by the entire study team” |
Sanchez et al. [35], IBH (Integrated Behavioral Health), USA | Depression and anxiety (in a low-income, uninsured adult population) | How a collaborative care model for the treatment of depression works | In-depth individual interviews | 4: 1 Care manager 1 PCP champion 1 Psychiatrist 1 Director | Analysis was partly guided by pre-developed propositions but “allowed for analytical flexibility and identification of new themes” |
Oishi et al. [29], IMPACT, USA | Late life depression | To explore how “’integration’ was achieved”, and to suggest “factors to consider when disseminating the model into real life settings” | Focus groups (2), semi-structured telephone interviews | 11 DCSs (care managers) | Thematic analysis |
Blasinsky et al. [41] IMPACT, USA | Major depressive disorder or dysthymia (older adults) | To investigate the sustainability of collaborative care in primary care | Semi-structured telephone interviews, documents describing the intervention, and site visits | Telephone interviews with 15 informants from 7 clinics: the principal investigator, co-principal investigator, depression care specialist (care manager), supervising psychiatrist, primary care physicians, program coordinator, and recruiter or screener | Not stated |
Palinkas et al. [39], MDDP (multifaceted depression and diabetes program for Hispanics), USA | Depression and diabetes | To examine “perceptions of barriers and facilitators associated with implementation and sustainability” | Individual semi-structured interviews and focus groups | 36: 5 Physicians (of which 3 were also clinic directors or associate directors) 9 Nurses 3 Nurse practitioners 19 Patients | Grounded theory approach |
Huang et al. [36], MHIP, USA | Depression (high-risk mothers) | To “explore aspects of the collaborative care program associated with successful treatment of depressed mothers served in a collaborative care program as well as barriers to such successes.” | Focus group interview | 6 Care managers | Thematic analysis |
Tai-Seale et al. [43], PCMH (Primary Care Mental Health Initiative), USA | Depression (veterans) | To “examine the effects of collaborative care on patient and primary care provider (PCP) experiences and communication during clinical encounters” | Audio recordings of 10 patient visits and a self-administered questionnaire | 6 PCPs | Qualitative analyses of transcripts using a pre-structured guide divided into six questions |
Nutting et al. [30], RESPECT-D, USA | Depression | “To understand the characteristics of organizations and the intervention components that were associated with implementation and dissemination” | Telephone interviews | 91: 24 Program managers (including quality improvement staff), 7 Mental health specialists, 18 Care managers, 42 Clinicians (“Most of the participating clinicians were family physicians, with only a few general internists, nurse-practitioners, and physician’s assistants”) | Data analysis in three waves focused on emerging themes |
Nutting et al. [38], RESPECT-D, USA | Depression | To examine the barriers to adopting depression care management among primary care clinicians | Semi-structured telephone interviews | 91: 24 Program managers 18 Care managers 7 Mental health specialists 42 Clinicians (“Most of the participating clinicians were family physicians, with only a few general internists, nurse-practitioners, and physician’s assistants”) | Data analysis in four waves focused on emerging themes |
Wozniak et al. [31], TeamCare Intervention, Canada | Diabetes and depression | To evaluate the implementation collaborative care model in community-based primary care networks (PCNs) | In-person or telephone interviews, reflections of the research team during the intervention and systematic documentation (e.g., standardized checklist, field notes, and meeting minutes). The PCN managers completed a standardized checklist at baseline The researchers documented their observations of and reflections on implementing TeamCare in each PCN, using a focus group format | 14 PCN staff (23 interviews) and 7 specialists (13 interviews) | Content analysis using the RE-AIM framework as well as a more inductive approach |
Quality assessment
Synthesis of results
Coherence
Cognitive participation
Collective action
Co-location and regular interaction
it’s just so much easier. She can stop me here immediately when she has a question, and we just hand the charts back and forth. We don’t have to have separate forms, … plus, we’ve found the patients very, very accepting of it when I see them and I prescribe a drug and I say, ‘[care manager name] is going to call you and see how you’re doing.’ They know who it is and there doesn’t have to be a lot of explanation or permission or anything. (clinician cited in [38] p. 35)
IT systems
The skills of the CMs
The patient encounter
Time and workload
Reflexive monitoring
NPT-dimensions | Enablers | Barriers |
---|---|---|
Coherence | Training [9] Physician champion [35] Clarification of roles and responsibilities among professionals [40, 42, 29] | Lack of educational programs [31] |
Cognitive participation | Professionals made aware of positive patient outcomes [41, 32, 38] Local opinion leaders [32, 35, 40] Covering PCPs operating costs related to collaborative care [40] Psychiatric supervision can ease scepticism among staff about medication [39] | Lack of engagement among the PCPs [33, 9, 32, 34, 37, 31] Time pressures [33, 9, 43, 38, 30] Problems with reimbursement [38] PCPs being uncomfortable with diagnosing and treating mental health illness [32, 34, 39] PCP concerns about sharing patients’ private health information [35] |
Collective action | Co-location of CM and PCP [9, 32, 37, 29, 39, 38, 40, 6] Regular face-to-face interaction between professionals [9, 32, 38, 29] Interaction between professionals being centered on patient cases [33] Face-to-face patient referral between professionals [40] Professionals able to engage with patients [36, 42, 39, 29] CMs’ social and professional skills, e.g. being visible, able to build relationships [33, 32, 34, 29, 40] Good educational programs for CMs [33, 34, 29, 40] Model not being burdensome or create a problems with workload [32, 41, 43] Instruments for including patients and keeping track of progress [34, 29, 35, 30] | Absence of co-location of CM and PCP [33, 9, 32, 34] Lack of space for additional staff [39, 32] Difficulties engaging patients due to patients’ problems being too severe or complex [9, 36] and/or due to patients’ preferences [6] Primary care staff having difficulties managing mental health problems [34] Making the model work experienced as consuming [39, 9, 30, 38] IT-systems hindered effective communication (e.g. double registration, limited access, lack of integration) [9, 37, 29, 39, 34]. |
Reflexive monitoring | Professionals experience that patients benefit from collaborate care [32, 35, 38] Primary care providers value systematic patient feedback [33, 32, 29, 38] and instruments for monitoring patient progress [34, 36, 35, 30] Systematic monitoring enable active follow up which strengthen implementation [29] | Lack of systems for monitoring patient progress [33] Absence of immediate access to objective data on patient progress [39] |