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Table 1 Study characteristics

From: Enablers and barriers to implementing collaborative care for anxiety and depression: a systematic qualitative review

Author, name of intervention study, country Disease Aim of study Data collection methods Respondents Data analysis/theoretical framework
Gask et al. [42], CADET, UK Depression To explore the work that “needs to be done to make a collaborative care intervention for depression in primary care both workable and integrated into routine practice” Focus groups, one-to-one interviews 49:
12 PCPs
4 Clinical psychologists
4 Practice nurses
4 Psychiatrists
14 Mental health workers
11 patients
Normalization process model (NPM)
Coupe et al. [9], CADET, UK Depression “To explore to what extent CC impacts on professional working relationships, and if CC for depression could be implemented as routine in the primary care setting.”
“To identify barriers and facilitators to the successful implementation of CC”
Face-to-face interviews with CM and managers
Telephone interviews with GPs
26:
6 CMs,
5 Supervisors from research team,
15 GPs
Thematic analysis and theory-driven analysis using normalization process theory (NPT)
Knowles et al. [37], COINSIDE, UK Depression and long-term conditions To explore (a) the extent to which “collaborative care principles and modes of working were implemented in routine care…”
and to (b) “Employ NPT as a conceptual model to identify barriers and facilitators to the adoption and integration of collaborative care…”
Face-to-face semi-structured interviews 23:
6 Case managers
17 Practice nurses
Thematic analysis and normalization process theory (NPT)
Knowles et al. [6], COINSIDE, UK Depression and long-term conditions “…to examine:
a) How the collaborative care model was implemented by usual care providers in a UK setting.
b) How patients and providers understood and experienced the integration of mental and physical health care.”
Semi-structured interviews 61:
11 PWPs
12 PNs,
7 GPs
31 Patients
The constant comparative method
Byng et al. [33], The Mental Health Link intervention (MHL), UK Patients with long-term mental illness To investigate how the MHL intervention “had its effects and how the process evaluation adds meaning to the results of the trial.” Individual and group interviews 49:
21 GPs,
8 Community
mental health workers,
7 Practice managers,
4 Mental health managers,
3 Practice nurses,
2 Psychiatrists,
1 Practice counselor
1 Facilitator
Case study using the realistic evaluation framework
Curran et al. [32], CALM, USA Anxiety To identify the facilitators and barriers to implement and sustain CALM Qualitative interviews 61:
14 Anxiety clinic specialists (ACS)
13 Primary care nurses
18 Primary care administrators
16 Primary care clinic administrators
Content analysis. Coding in three levels: 1: macro themes identified, 2: subcoding identifying barriers and facilitators, 3: interpretation
Eghaneyan et al. [34], (Collaborative care in a community health center), USA Depression, anxiety (in a low-income, uninsured Latino population) “To examine the implementation of a collaborative care model…” and “to identify perceived barriers…” Semi-structured interviews 7:
1 Care manager
3 PCPs
1 Nursing director
1 Project manager
1 CEO
Grounded theory approach. Two-leveled coding
Whitebird et al. [40], DIAMOND, USA Depression To identify the care model factors that were key for successful implementation of collaborative depression care Mixed methods study:
Group interviews plus “quantitative measures of patient activation and 6-month remission rates”
42 Clinics.
The exact number of respondents is not stated.
Present at the interviews were as follows:
“…the project lead, care manager and PCP champion. Other staff encouraged to attend were other physicians, the consulting psychiatrist, and the quality improvement lead”
“Following each site visit, ICSI staff completed a structured qualitative narrative to document their assessment of factors affecting implementation […]
Summaries were then prepared by the ICSI site-visit teams and were reviewed by the entire study team”
Sanchez et al. [35], IBH (Integrated Behavioral Health), USA Depression and anxiety (in a low-income, uninsured adult population) How a collaborative care model for the treatment of depression works In-depth individual interviews 4:
1 Care manager
1 PCP champion
1 Psychiatrist
1 Director
Analysis was partly guided by pre-developed propositions but “allowed for analytical flexibility and identification of new themes”
Oishi et al. [29], IMPACT, USA Late life depression To explore how “’integration’ was achieved”, and to suggest “factors to consider when disseminating the model into real life settings” Focus groups (2), semi-structured telephone interviews 11 DCSs (care managers) Thematic analysis
Blasinsky et al. [41] IMPACT, USA Major depressive disorder or dysthymia (older adults) To investigate the sustainability of collaborative care in primary care Semi-structured telephone interviews, documents describing the intervention, and site visits Telephone interviews with 15 informants from 7 clinics: the principal investigator, co-principal investigator, depression care specialist (care manager), supervising psychiatrist, primary care physicians, program coordinator, and recruiter or screener Not stated
Palinkas et al. [39], MDDP (multifaceted depression and diabetes program for Hispanics), USA Depression and diabetes To examine “perceptions of barriers and facilitators associated with implementation and sustainability” Individual semi-structured interviews and focus groups 36:
5 Physicians (of which 3 were also clinic directors or associate directors)
9 Nurses
3 Nurse practitioners
19 Patients
Grounded theory approach
Huang et al. [36], MHIP, USA Depression (high-risk mothers) To “explore aspects of the collaborative care program associated with successful treatment of depressed mothers served in a collaborative care program as well as barriers to such successes.” Focus group interview 6 Care managers Thematic analysis
Tai-Seale et al. [43], PCMH (Primary Care Mental Health Initiative), USA Depression (veterans) To “examine the effects of collaborative care on patient and primary care provider (PCP) experiences and communication during clinical encounters” Audio recordings of 10 patient visits and a self-administered questionnaire 6 PCPs Qualitative analyses of transcripts using a pre-structured guide divided into six questions
Nutting et al. [30], RESPECT-D, USA Depression “To understand the characteristics of organizations and the intervention components that were associated with implementation and dissemination” Telephone interviews 91:
24 Program managers (including quality improvement staff),
7 Mental health specialists,
18 Care managers,
42 Clinicians (“Most of the participating clinicians were family physicians, with only a few general internists, nurse-practitioners, and physician’s assistants”)
Data analysis in three waves focused on emerging themes
Nutting et al. [38], RESPECT-D, USA Depression To examine the barriers to adopting depression care management among primary care clinicians Semi-structured telephone interviews 91:
24 Program managers
18 Care managers
7 Mental health specialists
42 Clinicians (“Most of the participating clinicians were family physicians, with only a few general internists, nurse-practitioners, and physician’s assistants”)
Data analysis in four waves focused on emerging themes
Wozniak et al. [31], TeamCare Intervention, Canada Diabetes and depression To evaluate the implementation collaborative care model in community-based primary care networks (PCNs) In-person or telephone interviews, reflections of the research team during the intervention and systematic documentation (e.g., standardized checklist, field notes, and meeting minutes). The PCN managers completed a standardized checklist at baseline
The researchers documented their observations of and reflections on implementing TeamCare in each PCN, using a focus group format
14 PCN staff (23 interviews) and 7 specialists (13 interviews) Content analysis using the RE-AIM framework as well as a more inductive approach