Developing a U.K. protocol for collaborative care: a qualitative study.
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.


METHODS
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.
Richards
David A
DA
Department of Health Sciences, University of York, YO10 5DD, UK. dr17@york.ac.uk
Lankshear
Annette J
AJ
Fletcher
Janine
J
Rogers
Anne
A
Barkham
Michael
M
Bower
Pete
P
Gask
Linda
L
Gilbody
Simon
S
Lovell
Karina
K
D001291:Attitude of Health Personnel; D003299:Cooperative Behavior; D003657:Decision Making; D003863:Depression / Q000628:therapy*; D005240:Feasibility Studies; D017144:Focus Groups; D006801:Humans; D007400:Interprofessional Relations; D007407:Interviews as Topic; D008605:Mental Health Services / Q000458:organization & administration* / Q000592:standards; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D010348:Patient Care Team; D011320:Primary Health Care / Q000379:methods; D012944:Social Support; D013689:Telephone; D006113:United Kingdom