Abstract
BackgroundCollaborative and stepped care (CSC) models are recommended for mental disorders. Their successful implementation depends on effective collaboration between involved care providers from primary and specialist care. To gain insights into the collaboration experiences of care providers in CSC against the backdrop of usual mental health care, a qualitative process evaluation was realized as part of a cluster-randomized controlled trial (COMET) of a collaborative and stepped care model in Hamburg (Germany).MethodsSemi-structured interviews were conducted with N = 24 care providers from primary and specialist care (outpatient psychotherapists and psychiatrists, inpatient/ day clinic mental health providers) within and outside of COMET at the trial’s beginning and 12 months later. Interviews were analyzed applying a qualitative structuring content analysis approach, combining deductive and inductive category development.ResultsUsual mental health care was considered deficient in resources, with collaboration being scarce and mainly taking place in small informal networks. Within the COMET trial, quicker referral paths were welcomed, as were quarterly COMET network meetings which provided room for exchange and fostered mutual understanding. Yet, also in COMET, collaboration remained difficult due to communication problems, the unfavorable regional distribution of the COMET care providers and interprofessional discrepancies regarding each profession’s role, competencies and mutual esteem. Ideas for improvement included more localized networks, the inclusion of further professions and the overall amelioration of mental health care regarding resources and remuneration, especially for collaborative activities.ConclusionsThe process evaluation of the COMET trial revealed the benefits of creating room for interprofessional encounter to foster collaborative care. Despite the benefits of faster patient referrals, the COMET network did not fulfill all care providers’ prior expectations. A focus should be set on interprofessional competencies, mutual perception and role clarification, as these have been revealed as significant barriers to collaboration within CSC models such as COMET.Trial registrationThe COMET trial (Collaborative and Stepped Care in Mental Health by Overcoming Treatment Sector Barriers) has been registered on July 24, 2017 under the trial registration number NCT03226743.
Highlights
Collaborative and stepped care (CSC) models are recommended for mental disorders
A focus should be set on interprofessional competencies, mutual perception and role clarification, as these have been revealed as significant barriers to collaboration within CSC models such as COMET
While collaborative care models differ in their particular designs, the essential elements are: 1) team-driven care, i.e. care is provided in a coordinated way by a multidisciplinary group of health care providers, 2) population-focused, i.e. care aiming at a defined group of patients, in this case those with mental disorders, 3) measurement-guided, i.e. care being guided by systematic patient-oriented outcomes and 4) evidence-based care [10]
Summary
Collaborative and stepped care (CSC) models are recommended for mental disorders. Their successful implementation depends on effective collaboration between involved care providers from primary and specialist care. Guidelines in the UK, the Netherlands and Germany recommend collaborative and stepped care as models of health care provision for mental disorders [7,8,9]. While collaborative care models differ in their particular designs, the essential elements are: 1) team-driven care, i.e. care is provided in a coordinated way by a multidisciplinary group of health care providers, 2) population-focused, i.e. care aiming at a defined group of patients, in this case those with mental disorders, 3) measurement-guided, i.e. care being guided by systematic patient-oriented outcomes and 4) evidence-based care [10]. The adaptation of care intensity is assured by systematic monitoring and subsequent stepping up or down or maintaining of care intensity [11]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
