OBJECTIVE: This study aimed to explore the views of stakeholders including patients, general practitioners (GPs) and mental health workers on the feasibility, acceptability and barriers to a collaborative care model for treatment of depression within the context of U.K. primary health care. METHOD: We used semistructured interviews and focus groups with a purposive sample of 11 patients and 38 professionals from a wide selection of primary and secondary care mental health services, as well as framework analysis using a "constant comparative" approach to identify key concepts and themes. RESULTS: Regular contact for patients with depression is acceptable and valued by both patients and professionals. However, patients value support, whereas professionals focus on information. To be acceptable to patients, contacts about medication or psychosocial support must minimize the potential for patient disempowerment. The use of the telephone is convenient and lends anonymity, but established mental health workers think it will impair their judgments. While patients merely identified the need for skilled case managers, GPs preferred established professionals; however, these workers did not see themselves in this role. All involved were cautious about deploying new workers. Additional barriers included practical and organizational issues. CONCLUSIONS: Although a telephone-delivered mix of medication support and low-intensity psychological intervention is generally acceptable, significant issues to be addressed include the values of the current mental health workforce, fears about new workers' experience and competence, the balance of face-to-face and telephone contacts and case manager education in nonspecific skills necessary to develop a therapeutic alliance, as well as the knowledge and skills required for education, medication support and behavioral activation. Qualitative research can add value to careful modeling of collaborative care prior to international implementation.
OBJECTIVE: This study aimed to explore the views of stakeholders including patients, general practitioners (GPs) and mental health workers on the feasibility, acceptability and barriers to a collaborative care model for treatment of depression within the context of U.K. primary health care. METHOD: We used semistructured interviews and focus groups with a purposive sample of 11 patients and 38 professionals from a wide selection of primary and secondary care mental health services, as well as framework analysis using a "constant comparative" approach to identify key concepts and themes. RESULTS: Regular contact for patients with depression is acceptable and valued by both patients and professionals. However, patients value support, whereas professionals focus on information. To be acceptable to patients, contacts about medication or psychosocial support must minimize the potential for patient disempowerment. The use of the telephone is convenient and lends anonymity, but established mental health workers think it will impair their judgments. While patients merely identified the need for skilled case managers, GPs preferred established professionals; however, these workers did not see themselves in this role. All involved were cautious about deploying new workers. Additional barriers included practical and organizational issues. CONCLUSIONS: Although a telephone-delivered mix of medication support and low-intensity psychological intervention is generally acceptable, significant issues to be addressed include the values of the current mental health workforce, fears about new workers' experience and competence, the balance of face-to-face and telephone contacts and case manager education in nonspecific skills necessary to develop a therapeutic alliance, as well as the knowledge and skills required for education, medication support and behavioral activation. Qualitative research can add value to careful modeling of collaborative care prior to international implementation.
Authors: Jochen Gensichen; Cornelia Jaeger; Monika Peitz; Marion Torge; Corina Güthlin; Karola Mergenthal; Vera Kleppel; Ferdinand M Gerlach; Juliana J Petersen Journal: Ann Fam Med Date: 2009 Nov-Dec Impact factor: 5.166
Authors: Fransina J de Jong; Kirsten M van Steenbergen-Weijenburg; Klaas M L Huijbregts; Moniek C Vlasveld; Harm W J Van Marwijk; Aartjan T F Beekman; Christina M van der Feltz-Cornelis Journal: Int J Integr Care Date: 2009-06-15 Impact factor: 5.120
Authors: Linda Gask; Peter Bower; Karina Lovell; Diane Escott; Janine Archer; Simon Gilbody; Annette J Lankshear; Angela E Simpson; David A Richards Journal: Implement Sci Date: 2010-02-10 Impact factor: 7.327
Authors: Jane M Gunn; Victoria J Palmer; Christopher F Dowrick; Helen E Herrman; Frances E Griffiths; Renata Kokanovic; Grant A Blashki; Kelsey L Hegarty; Caroline L Johnson; Maria Potiriadis; Carl R May Journal: Implement Sci Date: 2010-08-06 Impact factor: 7.327
Authors: Victoria Palmer; Jane Gunn; Renata Kokanovic; Frances Griffiths; Bradley Shrimpton; Rosalind Hurworth; Helen Herrman; Caroline Johnson; Kelsey Hegarty; Grant Blashki; Ella Butler; Kate Johnston-Ata'ata; Christopher Dowrick Journal: Fam Pract Date: 2010-04-08 Impact factor: 2.267
Authors: David A Richards; Adwoa Hughes-Morley; Rachel A Hayes; Ricardo Araya; Michael Barkham; John M Bland; Peter Bower; John Cape; Carolyn A Chew-Graham; Linda Gask; Simon Gilbody; Colin Green; David Kessler; Glyn Lewis; Karina Lovell; Chris Manning; Stephen Pilling Journal: BMC Health Serv Res Date: 2009-10-16 Impact factor: 2.655
Authors: Christopher Dowrick; Linda Gask; Suzanne Edwards; Saadia Aseem; Peter Bower; Heather Burroughs; Amy Catlin; Carolyn Chew-Graham; Pam Clarke; Mark Gabbay; Simon Gowers; Derek Hibbert; Marija Kovandzic; Jonathan Lamb; Karina Lovell; Anne Rogers; Mari Lloyd-Williams; Waquas Waheed Journal: BMC Health Serv Res Date: 2009-12-10 Impact factor: 2.655