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Table 2 Convergence and divergence in referral procedures for Site Alpha

From: Between and within-site variation in qualitative implementation research

Redundant concept

Convergence or divergence

Supporting data

Psychologists are co-located in primary care

Convergence

MHL: Multiple revisions to service agreements were needed to tailor the implementation to primary care needs.

Divergence

PCP: PC/MHI could be expanded to help manage difficult medical patients.

Traditional consultation-liaison service

Convergence

MHL: PC/MHI supplements the consultation-liaison (POD) services.

Convergence

PCMH: POD services are separate from the implementation.

Divergence

PCMH: POD restricts access to specialty mental health.

Divergence

PCP: POD availability has improved since the implementation, but POD sometimes refers patients back to PC without treatment.

Implementation limited by a lack of space

Convergence

PCMH: Reported a growth in referrals since implementation and implemented innovative new procedures to make use of limited co-located staffing.

Convergence

PCP: Acknowledged improved access, but doubted long-term impact due to lack of space.

  1. Note: Supporting data are presented as either convergent or divergent with the redundant concept. MHL refers to the mental health leader at the site; PCMH refers to the Primary Care/Mental Health Integration (PC/MHI) informants at the site; PCP refers to the primary care physician informants at the site. POD = psychiatrist on duty.