Challenges of adopting the role of care manager when implementing the collaborative care model for people with common mental illnesses: A scoping review

Abstract

This review aimed to identify the main factors influencing the adoption of the role of care manager (CM) by nurses when implementing the collaborative care model (CCM) for common mental illnesses in primary care settings. A total of 19 studies met the inclusion criteria, reporting on 14 distinct interventions implemented between 2000 and 2017 in five countries. Two categories of factors were identified and described as follows: (i) strategies for the CCM implementation (e.g. initial care management training and supervision by a mental health specialist) and (ii) context‐specific factors (e.g. organizational factors, collaboration with team members, nurses’ care management competency). Identified implementation strategies were mainly aimed towards improving the nurse's care management competency, but their efficacy in developing the set of competencies needed to fulfil a CM role was not well demonstrated. There is a need to better understand the relationship between the nurses’ competencies, the care management activities, the strategies used to implement the CCM and the context‐specific factors. Strategies to optimize the adoption of the CM role should not be solely oriented towards the individual's competency in care management, but also consider other context‐specific factors. The CM also needs a favourable context in order to perform his or her activities with competency.

The care manager meeting the patients’ unique needs using the care manager model—A qualitative study of experienced care managers

“…The motivation among the care managers increased when meeting with other care managers. This is in line with Girard et al [ 26 ], who found that the competence of the care manager was important but that also the care managers’ activities and implementing strategies, as well as context specific factors, were ingredients that facilitated the adoption of the role. The structured model was praised, as it made the participants feel more secure about being able to provide equal health care.…”

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

“…We developed an interview guide for each type of participants (patients, PCNs, other primary care providers) to investigate current practices, challenges to nursing and collaborative care practices, and perceptions regarding an eventual change in practices. Interview guides were developed based on the results of previous studies on challenges to nursing and collaborative care practices for people with CMDs and long-term physical conditions in primary care clinics [ 15 34 ], and studies on barriers and enablers to implementing the CCM [ 17 18 19 ]. We reviewed the three interview guides respectively with a patient partner, a PCN, and a psychiatrist who were not otherwise involved in the study.…”

“…Indeed, routine PCN activities have considerable overlap with care manager activities: e.g., mental health status assessment, monitoring the efficacy and side effects of prescribed medications, adjusting treatments in collaboration with the GP, and providing psychoeducation [ 11 15 ]. Despite this overlap, CCM implementation teams have faced many challenges when promoting care manager activities to PCNs, who often felt they did not have sufficient skills and knowledge to manage mental health-related care competently [ 16 17 ]. PCNs also reported contextual barriers to the adoption of care manager activities such as lack of collaboration between team members, excessive workload, or competing priorities from the leadership [ 17 ].…”

“…Despite this overlap, CCM implementation teams have faced many challenges when promoting care manager activities to PCNs, who often felt they did not have sufficient skills and knowledge to manage mental health-related care competently [ 16 17 ]. PCNs also reported contextual barriers to the adoption of care manager activities such as lack of collaboration between team members, excessive workload, or competing priorities from the leadership [ 17 ]. On the other hand, contextual facilitators to the adoption of care manager activities include leadership interest in mental health and technical support from an implementation team [ 18 19 ].…”

Population-based implementation of behavioral health detection and treatment into primary care: early data from New York state

“…The PCP oversees all aspects of the patient’s care, including the prescription of all medications [ 5 ]. The behavioral health care manager is embedded in the primary care clinic and provides ongoing care coordination and collaboration with the team, including brief, evidence-based behavioral interventions to the patient, as well as routine symptom monitoring and treatment geared toward a measurable target/goal [ 6 ]. The psychiatric consultant meets with the BHCM regularly to systematically review cases and make treatment recommendations to the BHCM and PCP [ 7 ].…”