Barriers, facilitators, and proposals for improvement in the implementation of a collaborative care program for depression : a qualitative study of primary care physicians and nurses
Aragonès, Enric (Institut Català de la Salut. Atenció Primària Camp de Tarragona)
López-Cortacans, Germán (Institut Català de la Salut. Atenció Primària Camp de Tarragona)
Cardoner, N. (Narcís) (Centro de Investigación Biomédica en Red de Salud Mental)
Tomé-Pires, Catarina (Universidade Autónoma de Lisboa)
Porta-Casteràs, Daniel (Universitat Autònoma de Barcelona. Departament de Psiquiatria i de Medicina Legal)
Palao, Diego (Centro de Investigación Biomédica en Red de Salud Mental)
Primary Care Research Institute IDIAP Jordi Gol

Fecha:	2022
Resumen:	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: ; Registered 18th September, 2017.
Ayudas:	Generalitat de Catalunya. Departament de Salut PERIS-SLT002/16/00195 Generalitat de Catalunya. Departament de Salut PERIS-SLT002/16/00106
Derechos:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Lengua:	Anglès
Documento:	Article ; recerca ; Versió publicada
Materia:	Depressive disorder ; Primary health care ; Health plan implementation ; Disease management ; Qualitative research ; Focus groups
Publicado en:	BMC health services research, Vol. 22 (april 2022) , ISSN 1472-6963

DOI: 10.1186/s12913-022-07872-z
PMID: 35382822

11 p, 975.9 KB

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