Barriers and facilitators to the implementation of collaborative care for older people with depression: qualitative evaluation within the CASPERplus trial
The prevalence of depressive symptoms in older people may be as high as 20% and is often under-diagnosed and under-treated. A good evidence-base exists for the role of collaborative care (CC) in improving outcomes for people with depression, but how CC could be implemented in primary care for older people has not been explored.
A nested qualitative study within the CASPERplus randomized controlled trial for older people with moderate to severe depression (Collaborative Care for Screen Positive Elders). Twelve GPs, 8 case managers (CMs) and 13 patient participants were interviewed to explore understanding of the CC approach, and barriers and facilitators to implementation. Data were analysed using a framework approach, utilising Normalisation Process Theory (NPT).
Findings will be presented as they relate to NPT, focusing on how the CC model for the management of depression in older people might be implemented in primary care.
CMs understood the concept and value of CC and their role within it. Although GPs recognized the value of CC, they had little understanding of its conceptual basis. GPs and CMs suggested that they wished to work more closely together, but this was not operationalized. Participants suggested that it was valuable for the GP to be updated on patient risk and to receive patient progression summaries, but few GPs played an active role. Both patients and CMs felt that the initial face-to-face meeting was essential, prior to delivery of the intervention by telephone, although communication difficulties were highlighted as potential barriers in this patient group.
Increasing GPs’ understanding of CC might improve liaison and collaboration with CMs. A telephone-delivered intervention to older people with depression would be acceptable following an initial meeting, and offers the potential for implementation in a resource-poor health service.