Why Collaborative Care for Depressed Patients is so Difficult: A Belgian Qualitative Study

Broeck, Kris Van den; Ketterer, Frédéric; Remmen, Roy; Vanmeerbeek, Marc; Destoop, Marianne; Dom, Geert

doi:10.5334/ijic.2491

Cited by 7 publications

(7 citation statements)

References 22 publications

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“…Regardless of the clinical setting, optimal management for patients with MDD who experience R/R requires a multidisciplinary approach. For example, prior studies have demonstrated that collaboration among different healthcare providers benefits patients and can help mitigate relapse and monitor recurrence 19 , 20 . Also beneficial is the administration of symptom-based rating scales to aid in assessing symptom severity and informing treatment adjustments 19 , 21 .…”

Section: Discussionmentioning

confidence: 99%

Economic burden of relapse/recurrence in patients with major depressive disorder

Gauthier

Mucha

Shi

et al. 2019

Journal of Drug Assessment

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Objective : This study was conducted to determine the incremental healthcare resource utilization (HRU) and costs associated with relapse or recurrence (R/R) in patients with major depressive disorder (MDD) treated with antidepressants (AD) in US clinical practice. Methods : In this retrospective cohort study, adult patients with MDD treated with a branded AD were selected from the Truven Health Analytics MarketScan Databases (January 1, 2004–March 31, 2015). Time to first indicator of R/R was described. Characteristics, HRU, and costs were compared between patients with and without R/R. Among patients with R/R, HRU and costs were also compared between the pre- and post-R/R period. Results : From the 22,236 selected patients, 5,541 had ≥ 1 indicator of R/R and 16,695 did not. The 3-year R/R rate varied between 21.3% and 36.4% based on pattern of AD use (continuous, switch/augmentation, or early discontinuation). Patients with and without R/R presented different characteristics—notably, more intensive prior AD use and a higher comorbidity burden. HRU and costs were high in both patients with and without R/R but substantially higher among those with R/R ($20,590 vs $12,368 per-patient-per-year (PPPY); adjusted difference [aDiff] = $7,037), mainly driven by increased inpatient (IP) services (adjusted incidence rate ratio IP days = 3.95; aDiff IP costs = $3,433 PPPY). Among patients with R/R, emergency department visits, IP days, and IP admissions were over 2-times higher during the post-R/R period and total costs increased by over 50% from $19,267 to $29,419 in the post-R/R period. Conclusions : The economic burden in MDD patients is substantial, but is significantly higher among those who experience R/R.

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Section: Discussionmentioning

confidence: 99%

Economic burden of relapse/recurrence in patients with major depressive disorder

Gauthier

Mucha

Shi

et al. 2019

Journal of Drug Assessment

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“…Difficulties, however, are encountered when complex models such as these are integrated into clinical practice [ 12 , 13 ]. Our team designed and implemented a strategy for the widescale implementation of a multicomponent collaborative care program (INDI) designed to improve the management of depression in primary care centers within the Catalan public health system [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

Barriers, facilitators, and proposals for improvement in the implementation of a collaborative care program for depression: a qualitative study of primary care physicians and nurses

Aragonès

López-Cortacans

Cardoner

et al. 2022

BMC Health Serv Res

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Background Primary care plays a central role in the treatment of depression. Nonetheless, shortcomings in its management and suboptimal outcomes have been identified. Collaborative care models improve processes for the management of depressive disorders and associated outcomes. We developed a strategy to implement the INDI collaborative care program for the management of depression in primary health care centers across Catalonia. The aim of this qualitative study was to evaluate a trial implementation of the program to identify barriers, facilitators, and proposals for improvement. Methods One year after the implementation of the INDI program in 18 public primary health care centers we performed a qualitative study in which the opinions and experiences of 23 primary care doctors and nurses from the participating centers were explored in focus groups. We performed thematic content analysis of the focus group transcripts. Results The results were organized into three categories: facilitators, barriers, and proposals for improvement as perceived by the health care professionals involved. The most important facilitator identified was the perception that the INDI collaborative care program could be a useful tool for reorganizing processes and improving the management of depression in primary care, currently viewed as deficient. The main barriers identified were of an organizational nature: heavy workloads, lack of time, high staff turnover and shortages, and competing demands. Additional obstacles were inertia and resistance to change among health care professionals. Proposals for improvement included institutional buy-in to guarantee enduring support and the organizational changes needed for successful implementation. Conclusions The INDI program is perceived as a useful, viable program for improving the management of depression in primary care. Uptake by primary care centers and health care professionals, however, was poor. The identification and analysis of barriers and facilitators will help refine the strategy to achieve successful, widespread implementation. Trial registration ClinicalTrials.gov identifier: NCT03285659; Registered 18th September, 2017.

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“…The substantial amount of resources utilized to facilitate implementation, ranging from $208,314 to $236,263 per network excluding travel cost, is not surprising given the complexity of PCMHI [1,6,13], the difficulty of changing the structure and processes of care [15,39,40], the large number of contextual barriers that can hinder implementation [10,12,15,16,19], and the number of stakeholders that might need to be involved. Our study findings support the need to protect time for stakeholder participation in facilitation efforts.…”

Section: Discussionmentioning

confidence: 99%

“…Models of primary care mental health integration (PCMHI) are complex and challenging to implement, requiring change in the structure and processes of care delivery [2,6,10,11]; provider values, attitudes, roles, and skills [1,3,6,12,13]; and organizational culture [6,14,15], including ways of working together [6,12]. Further, primary care settings and their capacity for change vary widely [1,[14][15][16][17][18][19]. Thus, such programs and the implementation process must be tailored to the needs and resources of the organizational context and PCMHI stakeholders, e.g., leaders, providers, and other staff [10,17].…”

Section: Introductionmentioning

confidence: 99%

Time and Organizational Cost for Facilitating Implementation of Primary Care Mental Health Integration

et al. 2019

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Background Integrating mental health services into primary care settings is complex and challenging. Although facilitation strategies have successfully supported implementation of primary care mental health integration and other complex innovations, we know little about the time required or its cost. Objective To examine the time and organizational cost of facilitating implementation of primary care mental health integration. Design Descriptive analysis. Participants One expert external facilitator and two internal regional facilitators who helped healthcare system stakeholders, e.g., leaders, managers, clinicians, and non-clinical staff, implement primary care mental health integration at eight clinics. Intervention Implementation facilitation tailored to the needs and resources of the setting and its stakeholders. Main Measures We documented facilitators’ and stakeholders’ time and types of activities using a structured spreadsheet collected from facilitators on a weekly basis. We obtained travel costs and salary information. We conducted descriptive analysis of time data and estimated organizational cost. Key Results The external facilitator devoted 263 h (0.09 FTE), including travel, across all 8 clinics over 28 months. Internal facilitator time varied across networks (1792 h versus 1169 h), as well as clinics. Stakeholder participation time was similar across networks (1280.6 versus 1363.4 person hours) but the number of stakeholders varied (133 versus 199 stakeholders). The organizational cost of providing implementation facilitation also varied across networks ($263,490 versus $258,127). Stakeholder participation accounted for 35% of the cost of facilitation activities in one network and 47% of the cost in the other. Conclusions Although facilitation can improve implementation of primary care mental health integration, it requires substantial organizational investments that may vary by site and implementation effort. Furthermore, the cost of using an external expert to transfer facilitation skills and build capacity for implementation efforts appears to be minimal.

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Why Collaborative Care for Depressed Patients is so Difficult: A Belgian Qualitative Study

Cited by 7 publications

References 22 publications

Economic burden of relapse/recurrence in patients with major depressive disorder

Economic burden of relapse/recurrence in patients with major depressive disorder

Barriers, facilitators, and proposals for improvement in the implementation of a collaborative care program for depression: a qualitative study of primary care physicians and nurses

Time and Organizational Cost for Facilitating Implementation of Primary Care Mental Health Integration

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