چکیده (انگلیسی):

Background:Collaborative care (CC) is an organisational framework which facilitates the delivery of a mental
health intervention to patients by case managers in collaboration with more senior health professionals (supervisors
and GPs), and is effective for the management of depression in primary care. However, there remains limited
evidence on how to successfully implement this collaborative approach in UK primary care. This study aimed to
explore to what extent CC impacts on professional working relationships, and if CC for depression could be
implemented as routine in the primary care setting.
Methods:This qualitative study explored perspectives of the 6 case managers (CMs), 5 supervisors (trial research team
members) and 15 general practitioners (GPs) from practices participating in a randomised controlled trial of CC for
depression. Interviews were transcribed verbatim and data was analysed using a two-step approach using an initial
thematic analysis, and a secondary analysis using the Normalisation Process Theory concepts of coherence, cognitive
participation, collective action and reflexive monitoring with respect to the implementation of CC in primary care.
Results:Supervisors and CMs demonstrated coherence in their understanding of CC, and consequently reported good
levels of cognitive participation and collective action regarding delivering and supervising the intervention. GPs
interviewed showed limited understanding of the CC framework, and reported limited collaboration with CMs: barriers
to collaboration were identified. All participants identified the potential or experienced benefits of a collaborative
approach to depression management and were able to discuss ways in which collaboration can be facilitated.
Conclusion:Primary care professionals in this study valued the potential for collaboration, but GPs’ understanding of
CC and organisational barriers hindered opportunities for communication. Further work is needed to address these
organisational barriers in order to facilitate collaboration around individual patients with depression, including shared IT
systems, facilitating opportunities for informal discussion and building in formal collaboration into the CC framework.
Trial registration:ISRCTN32829227 30/9/2008