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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.