Challenges in conducting research on collaborative mental health care: a qualitative study

Abstract

C ollaborative mental health care involves primary care providers and mental health specialists working together in structured ways to improve access to care, quality of care and outcomes. 1,2 It is one of the most empirically supported approaches to achieving good outcomes in primary mental health care 2-7 and is integral to mental health and primary care strategies in Canada. 8-12 However, well-studied effective models of collaborative care have not been implemented in Canada. 13,14 The Primary Care Assessment and Research of a Telephone Intervention for Neuropsychiatric Conditions with Education and Resources study (PARTNERs) (Clinicaltrials. gov, no. NCT02345122) was designed to address geographic and human resource barriers that impede the implementation of collaborative care. It was a pragmatic randomized controlled trial assessing the implementation and effectiveness of a collaborative care model delivered by telephone versus enhanced usual care for people experiencing depression, anxiety or at-risk drinking, including mild to moderate alcohol use disorders. 15 The study intervention included telephone-based symptom monitoring and self-management support provided by a care manager, and recommendations from a psychiatrist to guide pharmacotherapy provided by primary care providers. The study outcomes were reduction in symptom severity and improved quality of life, measured 4, 8 and 12 months after baseline. The study had lower than expected referral rates. 16 We conducted a qualitative study with the aim of exploring primary care providers' experiences of PARTNERs, understanding barriers to and facilitators of collaborative care interventions and research, and informing the design of future studies.

Psychiatrist and Psychologist Experiences with Telehealth and Remote Collaborative Care in Primary Care: A Qualitative Study

“…Though communication with care managers went well, participants noted less frequent communication with PCPs, especially in the TER arm, which posed problems for patient care and satisfaction for some participants. Prior research has focused on collaborative care 27 , 29 ; our finding that communication with PCPs is a barrier in telemental health referral care is novel. Limited communication decreased PCPs’ implementation of telepsychiatrists’ recommendations, which is consistent with findings of a large collaborative care trial.…”

“…Staff turnover and variable orientation and buy‐in of oncoming staff are common telehealth issues. 22 , 26 , 27 , 29 , 31 , 36 , 47 , 48 Additionally, multiple participants mentioned that care managers were swamped in competing tasks, a known challenge in collaborative care 7 that may influence the aforementioned operational difficulties. Extra staff members to assist care managers in their tasks may be needed.…”

“… 19 , 20 , 21 , 22 , 23 Systems‐level barriers and facilitators to implementation have been elucidated in several studies. 8 , 19 , 20 , 23 , 24 , 25 , 26 Studies of provider‐level telehealth experiences are relatively sparse 22 , 27 , 28 , 29 , 30 with even fewer studies homing in on the experiences of remote telemental health consultants in integrated care. 31 , 32 To our knowledge, none of these studies on telemental health consultants have focused on rural telepsychiatry and collaborative care specifically.…”

“…Our objective was to understand the provider‐level barriers and facilitators of satisfaction with and implementation of collaborative care and telemental health referral care in primary care settings. Results can inform efforts to improve providers’ experiences, which could increase the dissemination of these models given the importance of “provider champions.” 22 , 29 , 30 , 34 We are adding to the sparse literature on telemental health care provider experiences by juxtaposing the implementation of collaborative care and telepsychiatry referral interventions and including both telepsychiatrists and telepsychologists.…”

The Influence of Contextual Factors on the Process of Formulating Strategies to Improve the Adoption of Care Manager Activities by Primary Care Nurses

“…Correspondingly, difficulty understanding the relative advantage of the model, lack of support from leaders, and perceived incompetence to manage care for people with CMDs are commonly mentioned barriers to implementing the CCM [ 18 19 ]. The presence of lead GPs interested in mental health is also recognized as facilitating the CCMs implementation [ 18 19 43 ]. In our study, interview participants were acutely aware of several of those barriers and enablers, which were at the forefront of local working groups discussions leading to strategy formulation.…”