Author:
Knowles Sarah E,Chew-Graham Carolyn,Coupe Nia,Adeyemi Isabel,Keyworth Chris,Thampy Harish,Coventry Peter A
Abstract
Abstract
Background
Mental-physical multi-morbidities pose challenges for primary care services that traditionally focus on single diseases. Collaborative care models encourage inter-professional working to deliver better care for patients with multiple chronic conditions, such as depression and long-term physical health problems. Successive trials from the United States have shown that collaborative care effectively improves depression outcomes, even in people with long-term conditions (LTCs), but little is known about how to implement collaborative care in the United Kingdom. The aim of the study was to explore the extent to which collaborative care was implemented in a naturalistic National Health Service setting.
Methods
A naturalistic pilot study of collaborative care was undertaken in North West England. Primary care mental health professionals from IAPT (Increasing Access to Psychological Therapies) services and general practice nurses were trained to collaboratively identify and manage patients with co-morbid depression and long-term conditions. Qualitative interviews were performed with health professionals at the beginning and end of the pilot phase. Normalization Process Theory guided analysis.
Results
Health professionals adopted limited elements of the collaborative care model in practice. Although benefits of co-location in primary care practices were reported, including reduced stigma of accessing mental health treatment and greater ease of disposal for identified patients, existing norms around the division of mental and physical health work in primary care were maintained, limiting integration of the mental health practitioners into the practice setting. Neither the mental health practitioners nor the practice nurses perceived benefits to joint management of patients.
Conclusions
Established divisions between mental and physical health may pose particular challenges for multi-morbidity service delivery models such as collaborative care. Future work should explore patient perspectives about whether greater inter-professional working enhances experiences of care. The study demonstrates that research into implementation of novel treatments must consider how the introduction of innovation can be balanced with the need for integration into existing practice.
Publisher
Springer Science and Business Media LLC
Subject
Public Health, Environmental and Occupational Health,Health Informatics,Health Policy,General Medicine
Reference27 articles.
1. Kendrick T, Dowrick C, McBride A, Howe A, Clarke P, Maisey S: Management of depression in UK general practice in relation to scores on depression severity questionnaires: analysis of medical record data. BMJ. 2009, 338 (mar19 1): b750-b750. 10.1136/bmj.b750.
2. Bayliss EA, Steiner JF, Fernald DH, Crane LA, Main DS: Descriptions of Barriers to Self-Care by Persons with Comorbid Chronic Diseases. Ann Fam Med. 2003, 1 (1): 15-21. 10.1370/afm.4.
3. Boyd CM, Fortin M, CMFC MDM: Future of Multimorbidity Research: How Should Understanding of Multimorbidity Inform Health System Design?. Public Health Rev. 2010, 32 (2): 451-74.
4. Mercer SW, Gunn J, Bower P, Wyke S, Guthrie B: Managing patients with mental and physical multimorbidity. BMJ. 2012, 345 (sep03 1): e5559-e5559. 10.1136/bmj.e5559.
5. Van Korff M, Katon W, Unutzer J, Wells K, Wagner E: Improving Depression Care Barriers, Solutions, and Research Needs. J Fam Pract. 2001, 50 (6): Available from: http://www.jfponline.com/pages.asp?aid=2253