Primary Care Area Camp de Tarragona, Catalan Health Institute, Carrer dels Horts, 6, 43120, Constantí, Tarragona, Spain.
Primary Care Research Institute IDIAP Jordi Gol, Barcelona, Spain.
BMC Health Serv Res. 2022 Apr 5;22(1):446. doi: 10.1186/s12913-022-07872-z.
Primary care plays a central role in the treatment of depression. Nonetheless, shortcomings in its management and suboptimal outcomes have been identified. Collaborative care models improve processes for the management of depressive disorders and associated outcomes. We developed a strategy to implement the INDI collaborative care program for the management of depression in primary health care centers across Catalonia. The aim of this qualitative study was to evaluate a trial implementation of the program to identify barriers, facilitators, and proposals for improvement.
One year after the implementation of the INDI program in 18 public primary health care centers we performed a qualitative study in which the opinions and experiences of 23 primary care doctors and nurses from the participating centers were explored in focus groups. We performed thematic content analysis of the focus group transcripts.
The results were organized into three categories: facilitators, barriers, and proposals for improvement as perceived by the health care professionals involved. The most important facilitator identified was the perception that the INDI collaborative care program could be a useful tool for reorganizing processes and improving the management of depression in primary care, currently viewed as deficient. The main barriers identified were of an organizational nature: heavy workloads, lack of time, high staff turnover and shortages, and competing demands. Additional obstacles were inertia and resistance to change among health care professionals. Proposals for improvement included institutional buy-in to guarantee enduring support and the organizational changes needed for successful implementation.
The INDI program is perceived as a useful, viable program for improving the management of depression in primary care. Uptake by primary care centers and health care professionals, however, was poor. The identification and analysis of barriers and facilitators will help refine the strategy to achieve successful, widespread implementation.
ClinicalTrials.gov identifier: NCT03285659 ; Registered 18th September, 2017.
初级保健在抑郁症的治疗中起着核心作用。尽管如此，在管理方面的不足和不理想的结果已经被确定。协作式护理模式可改善抑郁障碍及其相关结局的管理流程。我们开发了一种策略，以在加泰罗尼亚的初级保健中心实施 INDI 协作式护理项目，用于抑郁症的管理。本项定性研究旨在评估该项目的试点实施，以识别障碍、促进因素和改进建议。
在 18 家公共初级保健中心实施 INDI 项目一年后，我们进行了一项定性研究，探讨了参与中心的 23 名初级保健医生和护士的意见和经验。我们对焦点小组的转录本进行了主题内容分析。
结果分为三个类别：参与医疗保健专业人员认为的促进因素、障碍和改进建议。确定的最重要的促进因素是认为 INDI 协作式护理项目可以成为重新组织流程和改善初级保健中抑郁管理的有用工具，目前认为管理不足。确定的主要障碍具有组织性质：工作量大、时间不足、人员流动率高且人员短缺、以及需求竞争。另外的障碍是医疗保健专业人员的惯性和对变革的抵制。改进建议包括机构认可，以保证持久的支持和成功实施所需的组织变革。
INDI 项目被认为是改善初级保健中抑郁管理的有用、可行的方案。然而，初级保健中心和医疗保健专业人员的参与度很低。识别和分析障碍和促进因素将有助于完善策略，以实现成功和广泛的实施。
ClinicalTrials.gov 标识符：NCT03285659；注册于 2017 年 9 月 18 日。
