National Primary Care Research and Development Centre, University of Manchester, Oxford Road, Manchester UK.
Implement Sci. 2010 Feb 10;5:15. doi: 10.1186/1748-5908-5-15.
There is a considerable evidence base for 'collaborative care' as a method to improve quality of care for depression, but an acknowledged gap between efficacy and implementation. This study utilises the Normalisation Process Model (NPM) to inform the process of implementation of collaborative care in both a future full-scale trial, and the wider health economy.
Application of the NPM to qualitative data collected in both focus groups and one-to-one interviews before and after an exploratory randomised controlled trial of a collaborative model of care for depression.
Findings are presented as they relate to the four factors of the NPM (interactional workability, relational integration, skill-set workability, and contextual integration) and a number of necessary tasks are identified. Using the model, it was possible to observe that predictions about necessary work to implement collaborative care that could be made from analysis of the pre-trial data relating to the four different factors of the NPM were indeed borne out in the post-trial data. However, additional insights were gained from the post-trial interview participants who, unlike those interviewed before the trial, had direct experience of a novel intervention. The professional freedom enjoyed by more senior mental health workers may work both for and against normalisation of collaborative care as those who wish to adopt new ways of working have the freedom to change their practice but are not obliged to do so.
The NPM provides a useful structure for both guiding and analysing the process by which an intervention is optimized for testing in a larger scale trial or for subsequent full-scale implementation.
协作式护理作为一种提高抑郁症护理质量的方法，已经有了相当多的证据基础，但疗效和实施之间存在明显差距。本研究利用规范化进程模型（NPM）为未来的全面试验和更广泛的卫生经济中的协作式护理实施过程提供信息。
在对协作式护理模式进行探索性随机对照试验之前和之后，通过焦点小组和一对一访谈收集定性数据，并应用 NPM。
研究结果根据 NPM 的四个因素（交互可操作性、关系整合、技能集可操作性和环境整合）以及一些必要任务呈现。使用该模型，我们可以观察到，从对与 NPM 的四个不同因素相关的预试验数据的分析中，可以预测出实施协作式护理所需的必要工作，这些预测在试验后数据中得到了证实。然而，从试验后接受访谈的参与者那里获得了额外的见解，与试验前接受访谈的参与者不同，他们直接体验了一种新的干预措施。与那些希望采用新工作方式的人相比，更高级别的心理健康工作者享有的专业自由可能对协作式护理的规范化既有利又有弊，因为前者有自由改变自己的实践方式，但没有义务这样做。
NPM 为干预措施的优化提供了一个有用的结构，既可以指导试验，也可以分析干预措施，以便在更大规模的试验中进行测试或随后进行全面实施。
