Process evaluation of a cluster randomised intervention in Swedish primary care: using care managers in collaborative care to improve care quality for patients with depression

I Svenningsson,E-L Petersson,L Wallin,C Udo,J Westman,C Björkelund

doi:10.1186/s12875-019-0998-4

Abstract

BackgroundThe collaborative care model with a care manager has previously generated beneficial results for patients with depression in terms of decreased burden of depression symptoms. A care manager function has been tested in Sweden in the PRIM-CARE RCT with successful results. The aim of the present study was to evaluate the process of implementing care managers in collaborative care for patients with depression in Swedish primary health care in the PRIM-CARE RCT.MethodsThe study followed UK Medical Research Council guidance for process evaluation.Field notes from the implementation of the PRIM - CARE RCT were used, as well as data collected from five focus group discussions with General Practitioners (n = 29) and three focus group discussions with care managers (n = 11). Data were analysed with content analysis.ResultsTraining sessions, careful preparation and extensive initial support to the care manager and staff at the Primary Care Centres were important ingredients in the implementation. The close access to facilitators, the recurrent peer support meetings, and the weekly newsletter strengthened the care manager function.ConclusionsA complex intervention adapted to the Swedish primary care context focusing on a care manager function for patients with depression could be performed through a stepwise implementation process. Financial support from the health care regions included in the study helped to reduce the impact of identified barriers. This process evaluation has revealed new and important knowledge for primary care development concerning infrastructure and organization building, knowledge sharing, and facilitating factors and barriers.Trial registrationNCT02378272 Care Manager – Coordinating Care for Person Centered Management of Depression in Primary Care (PRIM – CARE). Registered March 4 2015. Retrospectively registered.

Highlights

The collaborative care model with a care manager has previously generated beneficial results for patients with depression in terms of decreased burden of depression symptoms
Contextual factors In Sweden, general practitioner (GP) traditionally have an influential position at the Primary care centre (PCC)
There was a shortage of GPs working at the PCCs, which reflects the general situation in Swedish primary health care

Summary

Introduction

The collaborative care model with a care manager has previously generated beneficial results for patients with depression in terms of decreased burden of depression symptoms. The aim of the present study was to evaluate the process of implementing care managers in collaborative care for patients with depression in Swedish primary health care in the PRIM-CARE RCT. Depression causes loss of quality of life and decreased functional ability, with economic and social consequences and increased risk of suicide [11]. These patients need to be taken care of at an early stage [12]. As PHC is the first instance where people with depression seek care, there is a need to develop methods to increase accessibility and continuity in care [9]

Objectives

Methods

Results

Discussion

Conclusion