Ruud Torleif, Rugkåsa Jorun, Haavet Ole Rikard, Dahli Mina Piiksi, Hanssen-Bauer Ketil, Brekke Mette, Tveit Ole Gunnar, Kates Nick, Hussain Ajmal
Division of Mental Health Services, Akershus University Hospital, Lørenskog, Norway.
Institute for Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway.
BMC Health Serv Res. 2025 Sep 2;25(1):1178. doi: 10.1186/s12913-025-13408-y.
Previous studies have shown that collaboration between primary care and mental health services can enhance accessibility and improve outcomes for patients seen in general practitioners' (GPs') office. There is, however, a lack of empirical evidence regarding the benefits of collaborative care in Norway. This study, part of a larger research project, examined the adaptation and implementation of a successful Canadian collaborative care model developed in Hamilton, Ontario, in three Norwegian GP practices located in different boroughs of Oslo, Norway's largest city.
To evaluate the required adaptations, implementation, challenges, and sustainability of the Hamilton model within the Norwegian context.
The overarching study was a cluster-randomised trial testing the adapted model in three urban GP practices over an 18-month period, with three additional GP practices from the same boroughs serving as control groups. Each intervention site included a half-time clinical psychologist from the local community mental health centre and a psychiatrist who visited for two hours each week. The project also aimed to extend collaboration to other health and community services within each borough. This paper evaluates the implementation of the project's intervention arm, using inductive thematic analysis of documents from all of the project's phases and following recommendations for the process evaluation of complex interventions.
The model's core component-collaboration between GPs and mental health specialists-was successfully implemented. Participating GPs appreciated the convenient access to mental health specialists to assist with managing mental health problems, although they faced challenges in finding time for collaboration. However, health policy restrictions on providing financial support for co-located collaborative care rendered the model unsustainable beyond the trial period and impeded its expansion to further GP practices.
The model was successfully implemented and viewed by participants as an improvement in healthcare delivery. For such a model to be sustained, however, adjustments must be made to align it with available resources, and reimbursements are needed for collaborative activities in GP practices. It also requires a recognition by funders and planners of the benefits of co-locating mental health specialists within GP practices.
先前的研究表明，初级保健与心理健康服务之间的合作可以提高可及性，并改善在全科医生（GP）诊所就诊患者的治疗效果。然而，在挪威，关于合作式护理益处的实证证据不足。本研究是一个更大研究项目的一部分，考察了在加拿大安大略省汉密尔顿市开发的一个成功的合作式护理模式，在挪威最大城市奥斯陆不同行政区的三家挪威全科医生诊所中的适应性和实施情况。
评估汉密尔顿模式在挪威背景下所需的适应性、实施情况、挑战及可持续性。
总体研究是一项整群随机试验，在18个月的时间里，在三家城市全科医生诊所测试该适应性模式，来自相同行政区的另外三家全科医生诊所作为对照组。每个干预点包括一名来自当地社区心理健康中心的兼职临床心理学家和一名每周出诊两小时的精神科医生。该项目还旨在将合作扩展到每个行政区内的其他健康和社区服务。本文使用对项目所有阶段文件的归纳主题分析，并遵循复杂干预过程评估的建议，评估项目干预组的实施情况。
该模式的核心组成部分——全科医生与心理健康专家之间的合作——得以成功实施。参与的全科医生赞赏能方便地获得心理健康专家的帮助以管理心理健康问题，尽管他们在寻找合作时间上面临挑战。然而，卫生政策对为同址合作式护理提供财政支持的限制，使得该模式在试验期之后无法持续，并阻碍了其向更多全科医生诊所的扩展。
该模式得以成功实施，参与者认为它改善了医疗服务的提供。然而，要使这样一个模式持续下去，必须进行调整以使其与可用资源相匹配，并且需要为全科医生诊所的合作活动提供报销。这还需要资助者和规划者认识到在全科医生诊所内同址设置心理健康专家的益处。
