Support for patient self-management | Coaching, problem solving, or psychoeducation or skills-focused psychotherapy to increase ability to manage symptoms and effectively participate in care and decision-making |
Lay provider (MHT) provided telephone monitoring and self-management support and, later, relapse prevention support; telephone calls were typically weekly × 3 mo, then monthly × 3 mo or potentially longer to a maximum of 1 yr MHT supervised weekly by study psychiatrist
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Seen as a unique and valuable resource for patients (in a broader climate of limited access) Strongly expected to be of benefit to many patients Telephone communication thought to vary in appeal and feasibility for patients Trusted that MHTs were qualified; some wanted more familiarity with them Would have liked greater integration of MHT into their setting, more frequent and bidirectional communication to share their knowledge of the patient and his or her past treatments, or co-location to enable “warm handoffs”
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Use of clinical information systems for timely data | Facilitated flow of patient- or population-level data to clinicians, e.g., via reports of patient results, case registries, reminder systems |
Patient’s FP or NP received individual patient data monthly × 3 mo (while MHT followed patient weekly), then quarterly (while MHT followed patient monthly) for a maximum of 1 yr Reports included Patient Health Questionnaire-9 score and other questionnaire scores as appropriate, a brief summary of care with MHT and any recommendations from study psychiatrist
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Theoretically useful, but some had difficulty recalling what they received, and blinded patient randomization also made their opinions difficult to interpret Could validate PCP impression, provide information not known to the PCP, or discuss referrals that were seen by the PCP as redundant or previously tried Telephone contact between MHT and PCP initiated by MHT was rare and greatly appreciated when it occurred; very rarely (if ever) initiated by PCP Rarely identified any changes to their practice as a result of receiving reports or knowing about MHT involvement (perhaps because of practice habits and small number of their patients involved with PARTNERs intervention)
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Delivery system redesign | Team-based care (v. physician-only care) to provide education, self-management support, information flow and overall proactive rather than reactive care |
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Embraced the concept of team-based primary care for people with common mental disorders, e.g., depression, anxiety; typically identified other conditions (e.g., bipolar disorder, posttraumatic stress disorder) as appropriate for follow-up in specialty care Many did not view the MHT care manager as an integrated member of the care team or a resource to the primary care setting
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Decision support for health care providers | On-site or distal psychiatrist consultation to PCPs or provision of simplified clinical practice guidelines supported by clinician champions |
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Linkage to community resources | Referrals to external resources to support clinical and nonclinical needs (e.g., peer support, exercise, home care) |
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Support for health care organizations | Leadership, training, staffing, informatics and other tangible resources to support adoption and implementation of collaborative care goals and practices |
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Identified as a major gap Leadership support for participation in PARTNERs varied greatly and influenced adoption and implementation Lack of training and ongoing support resulted in difficulty (e.g., knowing how to introduce the study to patients, whether the study was ongoing and continuing to accept new referrals) Interprofessional staff involvement (i.e., beyond physicians) would be required to facilitate more proactive care Staff turnover was common and created discontinuity in knowledge of and engagement with the study Informatics capabilities (e.g., searches or flags in the electronic medical record to facilitate identification of eligible patients) could assist with proactive care; again, would require interprofessional staff involvement
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