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Table 3 Convergence and divergence in referral procedures for Site Bravo

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

Redundant concept

Convergence or divergence

Supporting data

PC/MHI has improved access

Convergence

MHL: Co-location and the size of the clinic promote positive interactions, as providers see each other at lunch and at meetings.

 

Convergence

MHL: PC/MHI goal is immediate access; PCMH is always available.

Convergence

PCMH: Conducting a pilot study to provide access to walk-in patients.

Divergence

PCMH: Getting buy-in from PC is biggest challenge; informal discussions in the lunch room and “selling ourselves” increased curbside consults.

Divergence

PCP: Psychiatrists resisted helping PC manage behavioral aspects of chronic diseases, but negotiations have resulted in progress.

Referrals include standard referrals and curbside consults

Divergence

PCMH: Nurse routine screening often initiates referrals and some nurses refer patients inappropriately; working with nurse manager to educate staff.

Convergence

PCP: Norms indicate that knocking on doors is appropriate, even if it interrupts ongoing psychological care.

  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.