Lydia W Li1, Jiang Xue2, Yeates Conwell3, Qing Yang4, Shulin Chen2. 1. School of Social Work, University of Michigan, Ann Arbor, MI, USA. 2. Department of Psychology, Zhejiang University, Zhejiang Province, China. 3. Department of Psychiatry, University of Rochester, Rochester, NY, USA. 4. School of Public Health, Zhejiang University, Zhejiang Province, China.
Abstract
BACKGROUND: Depression often coexists with other chronic conditions in older people. The COACH study is an ongoing random controlled trial (RCT) to test the effectiveness of a primary-care-based collaborative care approach to treat co-morbid hypertension and depression in Chinese rural elders. In the COACH model, a team-village doctor (VD), aging worker (AW), and psychiatrist consultant-provides collaborative care to enrolled subjects in each intervention village for 12 months. This study examines how COACH was implemented and identifies facilitators and barriers for its more widespread implementation. METHODS: Five focus groups were conducted, two with VDs, two with AWs, and one with psychiatrists, for a total of 38 participants. Transcripts were analyzed using qualitative content analysis. RESULTS: COACH care-team members showed shared understanding and appreciation of the team approach and integrated management of hypertension and depression. Team collaboration was smooth. All members regarded COACH to be effective in reducing depressive symptoms and improving patient health. Facilitators to implementation include training, leaders' support, geographic proximity between VD and AW pairs, preexisting relationships among care-team members, comparability of COACH activities and existing practices of VDs and AWs, and care team members' caring about older members of their villages. Barriers to sustainability include frustration of some VDs related to their low wages and feelings of overload of some AWs. CONCLUSIONS: COACH was positively perceived and successfully implemented. The findings offer guidance for planning primary-care-based collaborative depression care in low- and middle-income countries.
BACKGROUND:Depression often coexists with other chronic conditions in older people. The COACH study is an ongoing random controlled trial (RCT) to test the effectiveness of a primary-care-based collaborative care approach to treat co-morbid hypertension and depression in Chinese rural elders. In the COACH model, a team-village doctor (VD), aging worker (AW), and psychiatrist consultant-provides collaborative care to enrolled subjects in each intervention village for 12 months. This study examines how COACH was implemented and identifies facilitators and barriers for its more widespread implementation. METHODS: Five focus groups were conducted, two with VDs, two with AWs, and one with psychiatrists, for a total of 38 participants. Transcripts were analyzed using qualitative content analysis. RESULTS: COACH care-team members showed shared understanding and appreciation of the team approach and integrated management of hypertension and depression. Team collaboration was smooth. All members regarded COACH to be effective in reducing depressive symptoms and improving patient health. Facilitators to implementation include training, leaders' support, geographic proximity between VD and AW pairs, preexisting relationships among care-team members, comparability of COACH activities and existing practices of VDs and AWs, and care team members' caring about older members of their villages. Barriers to sustainability include frustration of some VDs related to their low wages and feelings of overload of some AWs. CONCLUSIONS: COACH was positively perceived and successfully implemented. The findings offer guidance for planning primary-care-based collaborative depression care in low- and middle-income countries.
Entities:
Keywords:
LMICs; behavioral health in primary care settings; integrated care; mental-health-care access
Authors: Philip S Wang; Rhonda L Bohn; Eric Knight; Robert J Glynn; Helen Mogun; Jerry Avorn Journal: J Gen Intern Med Date: 2002-07 Impact factor: 5.128
Authors: Jeffrey F Scherrer; Hong Xian; Kathleen K Bucholz; Seth A Eisen; Michael J Lyons; Jack Goldberg; Ming Tsuang; William R True Journal: Psychosom Med Date: 2003 Jul-Aug Impact factor: 4.312
Authors: Cyrus Sh Ho; Liang Feng; Johnson Fam; Rathi Mahendran; Ee Heok Kua; Tze Pin Ng Journal: Int Psychogeriatr Date: 2014-04-15 Impact factor: 3.878
Authors: Meaghan A Kennedy; Kayla E Hatchell; Peter R DiMilia; Stephanie M Kelly; Heather B Blunt; Pamela J Bagley; Michael A LaMantia; Charles F Reynolds; Rebecca S Crow; Tara N Maden; S Logan Kelly; Jacqueline M Kihwele; John A Batsis Journal: J Am Geriatr Soc Date: 2021-03-18 Impact factor: 7.538
Authors: Clarissa Giebel; Nipun Shrestha; Siobhan Reilly; Ross G White; Maria Isabel Zuluaga; Gabriel Saldarriaga; Ginger Liu; Dawn Allen; Mark Gabbay Journal: BMC Geriatr Date: 2022-09-29 Impact factor: 4.070