TY - JOUR
KW - Adult
KW - Female
KW - Health Personnel
KW - Health Policy
KW - Humans
KW - intersectoral collaboration
KW - Male
KW - Mental Health
KW - Mental Health Services/organization & administration
KW - Middle Aged
KW - Norway
KW - Primary Health Care/organization & administration
KW - Psychiatry
KW - Qualitative Research
KW - Referral and Consultation
KW - Young Adult
KW - collaborative care
KW - Community Mental Health Centre
KW - Community mental health care
KW - GP mental health care
KW - Integrative care
KW - mental health care
KW - shared care
AU - J. Rugkasa
AU - O. G. Tveit
AU - J. Berteig
AU - A. Hussain
AU - T. Ruud
A1 - 
AB - BACKGROUND: Health policy in many countries directs treatment to the lowest effective care level and encourages collaboration between primary and specialist mental health care. A number of models for collaborative care have been developed, and patient benefits are being reported. Less is known about what enables and prevents implementation and sustainability of such models regarding the actions and attitudes of stakeholders on the ground. This article reports from a qualitative sub-study of a cluster-RCT testing a model for collaborative care in Oslo, Norway. The model involved the placement of psychologists and psychiatrists from a community mental health centre in each intervention GP practice. GPs could seek their input or advice when needed and refer patients to them for assessment (including assessment of the need for external services) or treatment. METHODS: We conducted in-depth qualitative interviews with GPs (n = 7), CMHC specialists (n = 6) and patients (n = 11) in the intervention arm. Sample specific topic guides were used to investigate the experience of enablers and barriers to the collaborative care model. Data were subject to stepwise deductive-inductive thematic analysis. RESULTS: Participants reported positive experiences of how the model improved accessibility. First, co-location made GPs and CMHC specialists accessible to each other and facilitated detailed, patient-centred case collaboration and learning through complementary skills. The threshold for patients' access to specialist care was lowered, treatment could commence early, and throughput increased. Treatment episodes were brief (usually 5-10 sessions) and this was too brief according to some patients. Second, having experienced mental health specialists in the team and on the front line enabled early assessment of symptoms and of the type of treatment and service that patients required and were entitled to, and who could be treated at the GP practice. This improved both care pathways and referral practices. Barriers revolved around the organisation of care. Logistical issues could be tricky but were worked out. The biggest obstacle was the funding of health care at a structural level, which led to economic losses for both the GP practices and the CMHC, making the model unsustainable. CONCLUSIONS: Participants identified a range of benefits of collaborative care for both patients and services. However, the funding system in effect penalises collaborative work. It is difficult to see how policy aiming for successful, sustainable collaboration can be achieved without governments changing funding structures. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT03624829.
AD - Health Services Research Unit, Akershus University Hospital, 1478, Lørenskog, Norway. jorun.rugkasa@ahus.no.; Centre for Care Research, University of South-Eastern Norway, Porsgrunn, Norway. jorun.rugkasa@ahus.no.; R&D Department of Mental Health, Akershus University Hospital, Lørenskog, Norway.; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.; Department of Acute Psychiatry Oslo University Hospital, Oslo, Norway.; Division of Mental Health Services, Akershus University Hospital, Lørenskog, Norway.; R&D Department of Mental Health, Akershus University Hospital, Lørenskog, Norway.; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
BT - BMC health services research
C5 - Education & Workforce
CP - 1
DO - 10.1186/s12913-020-05691-8
IS - 1
JF - BMC health services research
LA - eng
M1 - Journal Article
N2 - BACKGROUND: Health policy in many countries directs treatment to the lowest effective care level and encourages collaboration between primary and specialist mental health care. A number of models for collaborative care have been developed, and patient benefits are being reported. Less is known about what enables and prevents implementation and sustainability of such models regarding the actions and attitudes of stakeholders on the ground. This article reports from a qualitative sub-study of a cluster-RCT testing a model for collaborative care in Oslo, Norway. The model involved the placement of psychologists and psychiatrists from a community mental health centre in each intervention GP practice. GPs could seek their input or advice when needed and refer patients to them for assessment (including assessment of the need for external services) or treatment. METHODS: We conducted in-depth qualitative interviews with GPs (n = 7), CMHC specialists (n = 6) and patients (n = 11) in the intervention arm. Sample specific topic guides were used to investigate the experience of enablers and barriers to the collaborative care model. Data were subject to stepwise deductive-inductive thematic analysis. RESULTS: Participants reported positive experiences of how the model improved accessibility. First, co-location made GPs and CMHC specialists accessible to each other and facilitated detailed, patient-centred case collaboration and learning through complementary skills. The threshold for patients' access to specialist care was lowered, treatment could commence early, and throughput increased. Treatment episodes were brief (usually 5-10 sessions) and this was too brief according to some patients. Second, having experienced mental health specialists in the team and on the front line enabled early assessment of symptoms and of the type of treatment and service that patients required and were entitled to, and who could be treated at the GP practice. This improved both care pathways and referral practices. Barriers revolved around the organisation of care. Logistical issues could be tricky but were worked out. The biggest obstacle was the funding of health care at a structural level, which led to economic losses for both the GP practices and the CMHC, making the model unsustainable. CONCLUSIONS: Participants identified a range of benefits of collaborative care for both patients and services. However, the funding system in effect penalises collaborative work. It is difficult to see how policy aiming for successful, sustainable collaboration can be achieved without governments changing funding structures. TRIAL REGISTRATION: ClinicalTrials.gov identifier: NCT03624829.
PY - 2020
SN - 1472-6963; 1472-6963
SP - 844
T1 - Collaborative care for mental health: a qualitative study of the experiences of patients and health professionals
T2 - BMC health services research
TI - Collaborative care for mental health: a qualitative study of the experiences of patients and health professionals
U1 - Education & Workforce
U2 - 32907559
U3 - 10.1186/s12913-020-05691-8
VL - 20
VO - 1472-6963; 1472-6963
Y1 - 2020
Y2 - Sep 9
ER -