Implementing the collaborative care model : qualitative analysis fromhealthcare professionnals

Background



Depression and anxiety disorders present a significant challenge in France, often evading detection and treatment within primary care. Addressing this requires improved coordination between general practitioners (GPs) and specialized care. The collaborative care model, involving multidisciplinary teams, adopts a population-based approach with routine screening and case reviews by dedicated case managers and a remote psychiatrist. Evidence-based care includes psychotherapies delivered by case managers or psychologists, supported by standardized questionnaires for patient follow-up. While collaborative care has proven effective in international studies, conducting a specific implementation study in French primary care is now essential to comprehend the model's applicability, challenges, and adaptation within the French healthcare context Introduced in France in September 2021, the SESAME project is a pilot study involving four primary care practices, encompassing primary care teams and individual GPs. Nurse case managers with psychiatric expertise, play a key role within this framework.  



Objectives and methods



As part of a multidimensional implementation research initiative, this segment aims to explore the adoption and experiences of the collaborative care model among healthcare professionals (GPs, nurse case managers, and psychiatrists) in the initial phase of its establishment in France. Utilizing a qualitative approach, the study plans in-depth interviews with the entire healthcare professionals' cohort (n=20), investigating various dimensions of their experiences and emphasizing the barriers and facilitators in implementing the collaborative care protocol.



Findings and perspectives



SESAME meets physicians' needs by addressing time constraints and tackling challenges related to mental health expertise and access to psychiatrists. However unclear role distinctions within the team and the heavy reliance on the nurse both pose challenges. A comprehensive understanding and adherence to the referral framework, perceived by some doctors as overly restrictive, are also key components. Additional elements will be developed to further reflect the experience of the professionals involved in the protocol.