Stepped, Collaborative, Coordinated Care for Somatic Symptom and Related Disorders (Sofu-Net)

Abstract

Abstract. To improve early detection and adequate treatment for patients with somatic symptom and related disorders (SSRD), we implemented Sofu-Net, a stepped, collaborative, and coordinated health care network. This mixed-methods study aimed to evaluate Sofu-Net from the health care professionals’ perspective. Network partners (primary care physicians (PCPs), psychotherapists, inpatient mental health clinics) completed an evaluation survey. Following, qualitative analysis of focus groups explored facilitating factors and barriers of Sofu-Net. Of 66 network partners who completed the survey (response 83.5%), the majority was satisfied with Sofu-Net, and perceived improvements regarding management, early detection, and referral to mental health care. Both survey and focus groups identified interdisciplinary collaboration and diagnostic screening as most relevant facilitating factors. Important barriers to implementation included challenges in patient referral and structural factors. Necessary prerequisites for future stepped collaborative care for SSRD include structures facilitating diagnosis, inter-professional collaboration and referral, availability of mental health care, inclusion of comorbidities, and adequate reimbursement.

How do care providers evaluate collaboration? - qualitative process evaluation of a cluster-randomized controlled trial of collaborative and stepped care for patients with mental disorders

“…This has to be considered against the backdrop of the overall mental health care problems with lack of resources, deficits in remuneration of collaboration and high workload. These facts prominently emerged in the COMET study as inhibiting factors of the participants’ commitment and collaboration, concordant with previous trials [ 19 – 21 ].…”

“…In line with previous research [ 19 , 20 ], COMET PCPs and MHPs welcomed the benefits of participating in a network of committed care providers, sharing the goal of better caring for patients. Especially in the COMET PCPs’ eyes the study succeeded in allowing for shorter referral pathways, congruent to previous studies on collaborative and stepped care that solely focused on depression and on somatoform disorders [ 21 , 31 ]. While in COMET communication and feedback loops only slightly improved despite the participants’ wish, this represented an important component of collaboration in a systematic qualitative review by Overbeck et al [ 20 ] and should be addressed in future CSC models.…”

“…Semi-structured interviews were conducted at two time points during the COMET-trial: T1 at the beginning of the trial, T2 approximately one year after T1 to capture the changes within the CSC model, each incentivized monetarily. Based on research literature on implementation and previous CSC models [ 21 , 24 , 31 ] parallel interview guides were developed for both professional groups and time points of interviews (see Additional file 1 ). All interviews were conducted one-on-one between July 2018 and June 2020, mostly face-to-face in the care providers’ practices, during the coronavirus-pandemic via phone.…”

“…Facilitators for collaboration were identified in clear care provider roles, sufficient coordination and personal contacts [ 17 – 20 ]. In contrast, care providers in CSC studies criticized when collaboration came along with too many and/or not sufficiently remunerated tasks, against the background of already high workload and little treatment capacities [ 19 – 21 ]. Difficulties arose when interests of care providers diverged too largely [ 17 , 19 ] and when communication, interaction and/or feedback pathways were deficient, both structurally and on content-level [ 20 – 22 ].…”

Psychotherapeutische und ärztliche Inanspruchnahme bei persistierenden somatischen Symptomen: 4-Jahres-Katamnese des Netzwerks für somatoforme und funktionelle Störungen (Sofu-Net)

“…Auf Ebene der Einzelpatienten sollte eine mögliche Ambivalenz gegenüber der psychotherapeutischen Versorgung berücksichtigt werden. Hier leistet eine Netzwerkstruktur wie Sofu-Net einen relevanten Beitrag [33].…”