背景:协作护理模式(CoCM)是初级保健中基于证据的心理健康治疗。对成功实施CoCM的决定因素有更多的了解,特别是多层次实施者的特点,是需要的。
方法:本研究是对合作行为健康计划(CBHP)研究(NCT04321876)的过程评估,其中CoCM在11个初级保健实践中实施。CBHP的实施包括筛查抑郁和焦虑,转介给CBHP,以及行为护理经理(BCM)的治疗。面试是在实施后4个月和15个月与BCM进行的,实践经理,和实践冠军(初级保健临床医生)。我们将框架引导的快速定性分析与实施研究综合框架一起使用,2.0版,专注于个人领域,分析响应数据。这些数据代表了中层领导者(实践经理)的角色,实施小组成员(临床医生,支持人员),创新交付者(BCM),和创新接受者(初级保健/CBHP患者)及其特征(即,需要,能力,机会,动机)。
结果:中层领导(实践经理)对CBHP(动机)充满热情,赞赏将精神卫生服务纳入初级保健(需求),并有时间协助临床医生(机会)。尽管CBHP减轻了实施团队成员的负担(临床医生,工作人员;需要),有些人在重新分配患者护理方面犹豫不决(动机)。创新交付者(BCM)渴望提供CBHP(动机),并有信心帮助患者(能力);他们提供CBHP的机会可能会受到临床医生推荐(机会)的限制。尽管CBHP减轻了创新接受者(患者;需求)的障碍,很难为那些有严重条件(能力)和某些保险类型(机会)的人提供服务。
结论:总体而言,受访者赞成维持CoCM,并强调了对实践的积极影响,医疗队,和病人。与会者强调了将精神卫生服务纳入初级保健的好处,以及CBHP如何在为患者提供全面护理的同时减轻临床医生的负担。实施CBHP的障碍包括确保适当的患者转诊,为有更高层次需求的患者提供治疗,并激励临床医生参与。未来CoCM的实施应包括以教育和培训为重点的战略,鼓励临床医生买入,并为病情更严重或需求多样化的患者准备转诊路径。
背景:ClinicalTrials.gov(NCT04321876)。注册:2020年3月25日。追溯登记。
BACKGROUND: The Collaborative Care Model (CoCM) is an evidence-based mental health treatment in primary care. A greater understanding of the determinants of successful CoCM implementation, particularly the characteristics of multi-level implementers, is needed.
METHODS: This study was a process evaluation of the Collaborative Behavioral Health Program (CBHP) study (NCT04321876) in which CoCM was implemented in 11 primary care practices. CBHP implementation included screening for depression and anxiety, referral to CBHP, and treatment with behavioral care managers (BCMs). Interviews were conducted 4- and 15-months post-implementation with BCMs, practice managers, and practice champions (primary care clinicians). We used framework-guided rapid qualitative analysis with the Consolidated Framework for Implementation Research, Version 2.0, focused on the Individuals domain, to analyze response data. These data represented the roles of Mid-Level Leaders (practice managers), Implementation Team Members (clinicians, support staff), Innovation Deliverers (BCMs), and Innovation Recipients (primary care/CBHP patients) and their characteristics (i.e., Need, Capability, Opportunity, Motivation).
RESULTS: Mid-level leaders (practice managers) were enthusiastic about CBHP (Motivation), appreciated integrating mental health services into primary care (Need), and had time to assist clinicians (Opportunity). Although CBHP lessened the burden for implementation team members (clinicians, staff; Need), some were hesitant to reallocate patient care (Motivation). Innovation deliverers (BCMs) were eager to deliver CBHP (Motivation) and confident in assisting patients (Capability); their opportunity to deliver CBHP could be limited by clinician referrals (Opportunity). Although CBHP alleviated barriers for innovation recipients (patients; Need), it was difficult to secure services for those with severe conditions (Capability) and certain insurance types (Opportunity).
CONCLUSIONS: Overall, respondents favored sustaining CoCM and highlighted the positive impacts on the practice, health care team, and patients. Participants emphasized the benefits of integrating mental health services into primary care and how CBHP lessened the burden on clinicians while providing patients with comprehensive care. Barriers to CBHP implementation included ensuring appropriate patient referrals, providing treatment for patients with higher-level needs, and incentivizing clinician engagement. Future CoCM implementation should include strategies focused on education and training, encouraging clinician buy-in, and preparing referral paths for patients with more severe conditions or diverse needs.
BACKGROUND: ClinicalTrials.gov(NCT04321876). Registered: March 25,2020. Retrospectively registered.