title: Facilitating professional liaison in collaborative care for depression in UK primary care; a qualitative study utilising normalisation process theory.
abstract: 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.
  
  
  CONCLUSIONS
  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.
  
  
  BACKGROUND
  ISRCTN32829227 30/9/2008.
authors.forename: Nia
authors.initials: N
authors.lastname: Coupe
authors.forename: Emma
authors.initials: E
authors.lastname: Anderson
authors.forename: Linda
authors.initials: L
authors.lastname: Gask
authors.forename: Paul
authors.initials: P
authors.lastname: Sykes
authors.forename: David A
authors.initials: DA
authors.lastname: Richards
authors.affiliation: Centre for Primary Care, Institute of Population Health, Williamson Building, Oxford Road, University of Manchester, M13 9PL, Manchester, UK. c.a.chew-graham@keele.ac.uk.
authors.forename: Carolyn
authors.initials: C
authors.lastname: Chew-Graham
mesh_terms: D003299:Cooperative Behavior; D003863:Depression / Q000628:therapy*; D006801:Humans; D007400:Interprofessional Relations; D007407:Interviews as Topic; D011320:Primary Health Care / Q000458:organization & administration*; D036301:Qualitative Research; D013222:State Medicine / Q000458:organization & administration; D006113:United Kingdom