Health care assistants in primary care depression management: role perception, burdening factors, and disease conception.
OBJECTIVE
In primary care, the involvement of health care assistants (HCAs) in clinical depression management is an innovative approach. Little is known, however, about how HCAs experience their new tasks. We wanted to describe the perceptions and experiences of HCAs who provided case management to patients with depression in small primary care practices.


METHODS
This qualitative study was nested in the Primary Care Monitoring for Depressive Patients Trial on case management in Germany. We used a semi-structured instrument to interview 26 HCAs and undertook content analysis. We focussed on 3 key aspects: role perception, burdening factors, and disease conception.


RESULTS
Most HCAs said their new role provided them with personal and professional enrichment, and they were interested in improving patient-communication skills. They saw their major function as interacting with the patient and considered support for the family physician to be of less importance. Even so, some saw their role as a communication facilitator between family physician and patient. Burdening factors implementing the new tasks were the increased workload, the work environment, and difficulties interacting with depressed patients. HCAs' disease conception of depression was heterogeneous. After 1 year HCAs believed they were sufficiently familiar with their duties as case managers in depression management.


CONCLUSIONS
HCAs were willing to extend their professional responsibilities from administrative work to more patient-centred work. Even if HCAs perform only monitoring tasks within the case management concept, the resulting workload is a limiting factor.
Gensichen
Jochen
J
Institute for General Practice, University Hospital Jena, Friedrich-Schiller-University, Bachstr. 18, D-07740, Jena, Germany. jochen.gensichen@med.uni-jena.de
Jaeger
Cornelia
C
Peitz
Monika
M
Torge
Marion
M
Güthlin
Corina
C
Mergenthal
Karola
K
Kleppel
Vera
V
Gerlach
Ferdinand M
FM
Petersen
Juliana J
JJ
D000328:Adult; D000488:Allied Health Personnel / Q000193:education / Q000523:psychology*; D001291:Attitude of Health Personnel; D019090:Case Management; D003866:Depressive Disorder / Q000175:diagnosis* / Q000523:psychology; D005260:Female; D005858:Germany; D006801:Humans; D007588:Job Satisfaction; D011216:Practice Management, Medical; D011320:Primary Health Care; D012380:Role