A qualitative study of perceived needs and factors associated with the quality of care for common mental disorders in patients with chronic diseases: the perspective of primary care clinicians and patients.
The prevalence of comorbid anxiety and depressive disorders is high among patients with chronic diseases in primary care, and is associated with increased morbidity and mortality rates. The detection and treatment of common mental disorders in patients with chronic diseases can be challenging in the primary care setting. This study aims to explore the perceived needs, barriers and facilitators for the delivery of mental health care for patients with coexisting common mental disorders and chronic diseases in primary care from the clinician and patient perspectives.



In this qualitative descriptive study, we conducted semi-structured interviews with clinicians (family physician, nurse, psychologist, social worker; n = 18) and patients (n = 10) from three primary care clinics in Quebec, Canada. The themes explored included clinician factors (e.g., attitudes, perception of roles, collaboration, management of clinical priorities) and patient factors (e.g., needs, preferences, access to care, communication with health professionals) associated with the delivery of care. Qualitative data analysis was conducted based on an interactive cyclical process of data reduction, data display and conclusion drawing and verification.



Clinician interviews highlighted a number of needs, barriers and enablers in the provision of patient services, which related to inter-professional collaboration, access to psychotherapy, polypharmacy as well as communication and coordination of services within the primary care clinic and the local network. Two specific facilitators associated with optimal mental health care were the broadening of nurses' functions in mental health care and the active integration of consulting psychiatrists. Patients corroborated the issues raised by the clinicians, particularly in the domains of whole-person care, service accessibility and care management.



The results of this project will contribute to the development of quality improvement interventions to increase the uptake of organizational and clinical evidence-based practices for patients with chronic diseases and concurrent common mental disorders, in priority areas including collaborative care, access to psychotherapy and linkages with specialized mental health care.
Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, 3001, 12th Avenue North, Sherbrooke, QC, Canada. Pasquale.Roberge@USherbrooke.ca.|Université de Sherbrooke - Campus de la santé, Groupe de recherche PRIMUS, 3001, 12e avenue nord, Sherbrooke, QC, J1H 5N4, Canada. Pasquale.Roberge@USherbrooke.ca.
Pasquale
0000-0001-9929-8393
P
Roberge
Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, 3001, 12th Avenue North, Sherbrooke, QC, Canada.|Université de Sherbrooke - Campus de la santé, Groupe de recherche PRIMUS, 3001, 12e avenue nord, Sherbrooke, QC, J1H 5N4, Canada.
Catherine
C
Hudon
St. Mary's Hospital Center, 3830 Lacombe Avenue, Montreal, QC, Canada.
Alan
A
Pavilanis
Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, 3001, 12th Avenue North, Sherbrooke, QC, Canada.
Marie-Claude
MC
Beaulieu
Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, 3001, 12th Avenue North, Sherbrooke, QC, Canada.
Annie
A
Benoit
CISSS de la Montérégie-Est, 90 Sainte-Foy Boulevard, Longueuil, QC, Canada.
Hélène
H
Brouillet
Université de Sherbrooke, UMF Chicoutimi, 305, St-Vallier, Chicoutimi, QC, Canada.
Isabelle
I
Boulianne
St. Mary's Hospital Center, 3830 Lacombe Avenue, Montreal, QC, Canada.
Anna
A
De Pauw
Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, 3001, 12th Avenue North, Sherbrooke, QC, Canada.
Serge
S
Frigon
Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, 3001, 12th Avenue North, Sherbrooke, QC, Canada.|Université de Sherbrooke - Campus de la santé, Groupe de recherche PRIMUS, 3001, 12e avenue nord, Sherbrooke, QC, J1H 5N4, Canada.
Isabelle
I
Gaboury
Université de Sherbrooke, UMF Chicoutimi, 305, St-Vallier, Chicoutimi, QC, Canada.
Martine
M
Gaudreault
Université du Québec à Chicoutimi, 555, Boulevard de l'Université, Chicoutimi, QC, Canada.
Ariane
A
Girard
Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, 3001, 12th Avenue North, Sherbrooke, QC, Canada.
Marie
M
Giroux
Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, 3001, 12th Avenue North, Sherbrooke, QC, Canada.
Élyse
É
Grégoire
Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, 3001, 12th Avenue North, Sherbrooke, QC, Canada.
Line
L
Langlois
Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, 3001, 12th Avenue North, Sherbrooke, QC, Canada.
Martin
M
Lemieux
Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, 3001, 12th Avenue North, Sherbrooke, QC, Canada.
Christine
C
Loignon
Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, 3001, 12th Avenue North, Sherbrooke, QC, Canada.|Université de Sherbrooke - Campus de la santé, Groupe de recherche PRIMUS, 3001, 12e avenue nord, Sherbrooke, QC, J1H 5N4, Canada.
Alain
A
Vanasse
D000328:Adult; D001007:Anxiety / Q000150:complications / Q000628:therapy*; D001291:Attitude of Health Personnel; D002318:Cardiovascular Diseases / Q000150:complications; D002908:Chronic Disease; D003142:Communication; D003299:Cooperative Behavior; D003863:Depression / Q000150:complications / Q000628:therapy*; D005260:Female; D005767:Gastrointestinal Diseases / Q000150:complications; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006801:Humans; D007400:Interprofessional Relations; D007407:Interviews as Topic; D008171:Lung Diseases / Q000150:complications; D008297:Male; D008605:Mental Health Services / Q000592:standards*; D008875:Middle Aged; D009140:Musculoskeletal Diseases / Q000150:complications; D024802:Nurse's Role; D009726:Nurses / Q000523:psychology; D057240:Patient Preference; D010361:Patients / Q000523:psychology; D010819:Physician's Role; D010821:Physicians, Family / Q000523:psychology; D011320:Primary Health Care; D011584:Psychology; D036301:Qualitative Research; D011787:Quality of Health Care; D000068217:Social Workers / Q000523:psychology; D014570:Urologic Diseases / Q000150:complications
Anxiety disorders; Chronic diseases; Major depression; Patient experience; Primary care; Qualitative research; Quality improvement; Treatment