Refining a model of collaborative care for people with a diagnosis of bipolar, schizophrenia or other psychoses in England: a qualitative formative evaluation

Elina Baker,Ameeta Retzer,Vanessa Pinfold,Richard Byng,Laura Gill,Nicky Britten,Humera Plappert,Max Birchwood,Catherine Mccabe,Linda Gask,Siobhan Reilly,Maria Cox,Ruth Gwernan-Jones

doi:10.1186/s12888-018-1997-z

Abstract

BackgroundMany people diagnosed with schizophrenia, bipolar or other psychoses in England receive the majority of their healthcare from primary care. Primary care practitioners may not be well equipped to meet their needs and there is often poor communication with secondary care. Collaborative care is a promising alternative model but has not been trialled specifically with this service user group in England. Collaborative care for other mental health conditions has not been widely implemented despite evidence of its effectiveness. We carried out a formative evaluation of the PARTNERS model of collaborative care, with the aim of establishing barriers and facilitators to delivery, identifying implementation support requirements and testing the initial programme theory.MethodsThe PARTNERS intervention was delivered on a small scale in three sites. Qualitative data was collected from primary and secondary care practitioners, service users and family carers, using semi-structured interviews, session recordings and tape-assisted recall. Deductive and inductive thematic analysis was carried out; themes were compared to the programme theory and used to inform an implementation support strategy.ResultsKey components of the intervention that were not consistently delivered as intended were: interaction with primary care teams, the use of coaching, and supervision. Barriers and facilitators identified were related to service commitment, care partner skills, supervisor understanding and service user motivation. An implementation support strategy was developed, with researcher facilitation of communication and supervision and additional training for practitioners. Some components of the intervention were not experienced as intended; this appeared to reflect difficulties with operationalising the intervention. Analysis of data relating to the intended outcomes of the intervention indicated that the mechanisms proposed in the programme theory had operated as expected.ConclusionsAdditional implementation support is likely to be required for the PARTNERS model to be delivered; the effectiveness of such support may be affected by practitioner and service user readiness to change. There is also a need to test the programme theory more fully. These issues will be addressed in the process evaluation of our full trial.Trial registrationISRCTN95702682, 26 October 2017.

Highlights

Many people diagnosed with schizophrenia, bipolar or other psychoses in England receive the majority of their healthcare from primary care
Sixteen service users, five family carers and sixteen practitioners participated in the formative evaluation; distribution of participants across the three sites is shown in Table 4, along with the demographic data
Our results indicate that recovery-focussed collaborative care for people with a diagnosis of bipolar, schizophrenia or other psychoses is most likely to be implemented when the primary care team are receptive and the secondary care practitioner is prepared to adopt new working practices, including a pro-active approach to liaison and a more positive approach to risk

Summary

Introduction

Many people diagnosed with schizophrenia, bipolar or other psychoses in England receive the majority of their healthcare from primary care. There is evidence that primary care is centrally involved with the care of people with a diagnosis of schizophrenia, bipolar or other psychoses in the UK: Reilly et al [3] found that nearly a third were seen only in primary care and those seen in secondary care received only minimal support. These authors identified a number of obstacles to primary care practitioners supporting this group to achieve improved outcomes, including a lack of continuity of care within primary care teams and poor continuity and information exchange at the interface with secondary care [3]. Trials that have included people with a diagnosis of bipolar, schizophrenia or other psychoses have principally taken place in the USA, with none in the UK, where the organisation and funding of healthcare provision is substantially different

Methods

Results

Discussion

Conclusion