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

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• dc.contributor.author Aragonès, Enric
• dc.contributor.author López-Cortacans, Germán
• dc.contributor.author Cardoner, Narcís
• dc.contributor.author Tomé-Pires, Catarina
• dc.contributor.author Porta-Casteràs, Daniel
• dc.contributor.author Palao Vidal, Diego J.
• dc.contributor.author INDI·I Research Team
• dc.date.accessioned 2023-07-07T06:51:45Z
• dc.date.available 2023-07-07T06:51:45Z
• dc.date.issued 2022
• dc.description.abstract 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.
• dc.format.mimetype application/pdf
• dc.identifier.citation Aragonès E, López-Cortacans G, Cardoner N, Tomé-Pires C, Porta-Casteràs D, Palao D; INDI·I Research Team. 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. BMC Health Serv Res. 2022 Apr 5;22(1):446. DOI: 10.1186/s12913-022-07872-z
• dc.identifier.doi http://dx.doi.org/10.1186/s12913-022-07872-z
• dc.identifier.issn 1472-6963
• dc.identifier.uri http://hdl.handle.net/10230/57496
• dc.language.iso eng
• dc.publisher BioMed Central
• dc.relation.ispartof BMC Health Serv Res. 2022 Apr 5;22(1):446
• dc.rights © The Author(s) 2022. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
• dc.rights.accessRights info:eu-repo/semantics/openAccess
• dc.rights.uri http://creativecommons.org/licenses/by/4.0/
• dc.subject.keyword Depressive disorder
• dc.subject.keyword Disease management
• dc.subject.keyword Focus groups
• dc.subject.keyword Health plan implementation
• dc.subject.keyword Primary health care
• dc.subject.keyword Qualitative research
• dc.title 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
• dc.type info:eu-repo/semantics/article
• dc.type.version info:eu-repo/semantics/publishedVersion