Overbeck Gritt, Davidsen Annette Sofie, Kousgaard Marius Brostrøm
The Research Unit for General Practice and Section of General Practice, Institute of Public Health, University of Copenhagen, København, Denmark.
Implement Sci. 2016 Dec 28;11(1):165. doi: 10.1186/s13012-016-0519-y.
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.
We developed a comprehensive search strategy in cooperation with a research librarian and performed a search in five databases (EMBASE, PubMed, PsycINFO, 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 based on the 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 the normalization process theory (NPT).
We included 17 studies in our review of which 11 were conducted in the USA, five in the UK, and one in Canada. 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. Day-to-day implementation was also found to be facilitated by the care managers being located in the clinic since this supports regular face-to-face interactions between physicians and care managers.
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 settings outside the USA and the UK.
协作式照护是一种越来越受欢迎的方法，旨在通过初级保健提供者与具有专业精神科专业知识的卫生专业人员之间加强和结构化的协作，提高对有心理健康问题者的照护质量。试验表明，协作式照护对抑郁症患者有显著的积极效果，但由于协作式照护是一种复杂的干预措施，了解影响其实施的因素很重要。我们对为焦虑症和抑郁症患者实施协作式照护的促进因素和障碍进行了定性系统评价。
我们与一位研究馆员合作制定了全面的检索策略，并在五个数据库（EMBASE、PubMed、PsycINFO、ProQuest和CINAHL）中进行检索。所有作者独立筛选标题和摘要，并审阅全文文章。纳入的研究需以英文发表，且基于高收入国家成年患者群体中针对抑郁症或焦虑症实施协作式照护干预的原始定性数据。我们随后的分析采用了规范化过程理论（NPT）。
我们的综述纳入了17项研究，其中11项在美国进行，5项在英国进行，1项在加拿大进行。我们在NPT的四个主要分析维度中确定了几个障碍和促进因素。发现确保初级保健提供者的支持至关重要，但有时也很困难。促进因素包括医师倡导者、额外工作的报销以及关于协作式照护有效性的反馈。照护经理的社交和专业技能似乎对于将协作式照护整合到初级卫生保健诊所至关重要。还发现由于照护经理驻在诊所，日常实施得到了促进，因为这支持了医师和照护经理之间定期的面对面互动。
在规划协作式照护干预措施时，以下领域需要特别关注：有效的教育项目，尤其是针对照护经理的；与初级保健提供者相关的报销问题；良好的沟通和监测系统；以及促进照护经理和医师之间的面对面互动，最好是通过同地办公。需要在美国和英国以外的环境中对协作式照护的实施进行抽样充分、深入的定性研究。
