BackgroundThe 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.MethodsIn 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.ResultsClinician 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.ConclusionsThe 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.Electronic supplementary materialThe online version of this article (doi:10.1186/s12875-016-0531-y) contains supplementary material, which is available to authorized users.

Family Medicine Groups (FMGs) are the most recently developed primary care organizations in Quebec (Canada). Nurses within FMGs play a central role for patients with chronic diseases (CD). However, this complex role and the nursing activities related to this role vary across FMGs. Inadequate knowledge of nursing activities limits the implementation of exemplary nursing practices. This study aimed to describe FMG nursing activities with patients with CD and to describe the facilitators and barriers to these activities. A multiple-case study was performed with ten nurses practicing among patients with CD in FMGs. Five data sources were used to provide an in-depth description of nursing activities and the facilitators and barriers to the development of these activities. After qualitative data analysis, findings show that nursing activities are clustered into five domains: Global assessment of the patient, Care management, Health promotion, Nurse-physician collaboration, and Planning services for patients with CD. Activities vary depending on contextual factors identified in each case. This multiple-case study provides a clear description of nursing activities with patients with CD. There is a need for improved nursing activities and expertise in domains of activities that are less present in FMGs, such as case management and interprofessional collaboration.

Primary care nurses would benefit from gaining more knowledge about common mental disorders and from identifying the resources they need to contribute to managing them in an interdisciplinary team.

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This review aimed to identify the main factors influencing the adoption of the role of care manager (CM) by nurses when implementing the collaborative care model (CCM) for common mental illnesses in primary care settings. A total of 19 studies met the inclusion criteria, reporting on 14 distinct interventions implemented between 2000 and 2017 in five countries. Two categories of factors were identified and described as follows: (i) strategies for the CCM implementation (e.g. initial care management training and supervision by a mental health specialist) and (ii) context‐specific factors (e.g. organizational factors, collaboration with team members, nurses’ care management competency). Identified implementation strategies were mainly aimed towards improving the nurse's care management competency, but their efficacy in developing the set of competencies needed to fulfil a CM role was not well demonstrated. There is a need to better understand the relationship between the nurses’ competencies, the care management activities, the strategies used to implement the CCM and the context‐specific factors. Strategies to optimize the adoption of the CM role should not be solely oriented towards the individual's competency in care management, but also consider other context‐specific factors. The CM also needs a favourable context in order to perform his or her activities with competency.

Background Collaborative care is an evidence-based approach to improving outcomes for common mental disorders in primary care. Efforts are underway to broadly implement the collaborative care model, yet the extent to which this model promotes person-centered mental health care has been little studied. The aim of this study was to describe practices related to two patient and family engagement strategies–personalized care planning and shared decision making–within collaborative care programs for depression and anxiety disorders in primary care. Methods We conducted an update of a 2012 Cochrane review, which involved searches in Cochrane CCDAN and CINAHL databases, complemented by additional database, trial registry, and cluster searches. We included programs evaluated in a clinical trials targeting adults or youth diagnosed with depressive or anxiety disorders, as well as sibling reports related to these trials. Pairs of reviewers working independently selected the studies and data extraction for engagement strategies was guided by a codebook. We used narrative synthesis to report on findings. Results In total, 150 collaborative care programs were analyzed. The synthesis showed that personalized care planning or shared decision making were practiced in fewer than half of programs. Practices related to personalized care planning, and to a lesser extent shared decision making, involved multiple members of the collaborative care team, with care managers playing a pivotal role in supporting patient and family engagement. Opportunities for quality improvement were identified, including fostering greater patient involvement in collaborative goal setting and integrating training and decision aids to promote shared decision making. Conclusion This review suggests that personalized care planning and shared decision making could be more fully integrated within collaborative care programs for depression and anxiety disorders. Their absence in some programs is a missed opportunity to spread person-centered mental health practices in primary care.

Introduction : les infirmières en soins de première ligne assurent le suivi des patients atteints de maladies chroniques (MC), en collaboration avec le médecin traitant. Les activités effectuées varient d'un milieu à l'autre. Contexte : l'absence de données probantes sur les activités des infirmières des soins de première ligne nuit au développement de la pratique infirmière. Objectif : décrire les activités des infirmières en soins de première ligne auprès des personnes atteintes de MC et les éléments qui influencent ces activités. Devis : revue systématique de la littérature. Méthode : consultation des banques de données MEDLINE, CINAHL et SCOPUS. Mots-clés : Primary health care, Primary nursing and Chronic disease. Résultats : dix-huit articles ont été retenus. Quatre domaines d'activités décrivent les activités des infirmières : 1) Évaluation de la condition globale de la personne atteinte de MC ; 2) Gestion des soins ; 3) Promotion de la santé ; 4) Collaboration infirmière-médecin. Des éléments reliés à l'environnement, à l'infirmière ou à la personne atteinte de MC influencent les activités. Discussion : les activités des infirmières en soins de première ligne sont peu décrites. Certaines activités comme la gestion de cas et la collaboration interprofessionnelle sont absentes. Conclusion : des études descriptives sont nécessaires pour mieux décrire l'éventail des activités.

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