Abstract
Objective: Explore general practitioners’ (GPs’) views on and experiences of working with care managers for patients treated for depression in primary care settings. Care managers are specially trained health care professionals, often specialist nurses, who coordinate care for patients with chronic diseases.Design: Qualitative content analysis of five focus-group discussions.Setting: Primary health care centers in the Region of Västra Götaland and Dalarna County, Sweden.Subjects: 29 GPs.Main outcome measures: GPs’ views and experiences of care managers for patients with depression.Results: GPs expressed a broad variety of views and experiences. Care managers could ensure care quality while freeing GPs from case management by providing support for patients and security and relief for GPs and by coordinating patient care. GPs could also express concern about role overlap; specifically, that GPs are already care managers, that too many caregivers disrupt patient contact, and that the roles of care managers and psychotherapists seem to compete. GPs thought care managers should be assigned to patients who need them the most (e.g. patients with life difficulties or severe mental health problems). They also found that transition to a chronic care model required change, including alterations in the way GPs worked and changes that made depression treatment more like treatment for other chronic diseases.Conclusion: GPs have varied experiences of care managers. As a complementary part of the primary health care team, care managers can be useful for patients with depression, but team members’ roles must be clear.KEY POINTSA growing number of primary health care centers are introducing care managers for patients with depression, but knowledge about GPs’ experiences of this kind of collaborative care is limited.GPs find that care managers provide support for patients and security and relief for GPs.GPs are concerned about potential role overlap and desire greater latitude in deciding which patients can be assigned a care manager.GPs think depression can be treated using a chronic care model that includes care managers but that adjusting to the new way of working will take time.
Highlights
Primary health care plays a crucial role in treating patients with chronic diseases [1,2], which can include depression [2,3,4], one of the most common mental disorders and a major source of disability worldwide [5]
Four categories of experiences emerged from the analysis: Care managers ensure care quality while freeing general practitioners’ (GPs) from case management, Concern about role overlap, Care managers should be assigned to patients who Someone who calls and checks on patients
GPs thought care managers could be useful for patients with depression, but their role must be clear
Summary
Primary health care plays a crucial role in treating patients with chronic diseases [1,2], which can include depression [2,3,4], one of the most common mental disorders and a major source of disability worldwide [5]. Primary care has increasingly turned to chronic disease management models to improve care quality and continuity for patients with chronic diseases [1]. Inspired by these models, collaborative care interventions seek to improve patient care [7], for example by facilitating patients’ self-management efforts and adherence to treatment. Collaborative care interventions seek to improve patient care [7], for example by facilitating patients’ self-management efforts and adherence to treatment They promote communication, coordination, and involvement of health care providers in and outside primary care [8]. Employing care managers to support patients with depression is new in Swedish primary health care [25]
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