How should we implement collaborative care for older people with depression? A qualitative study using normalisation...

Area of Science:

• Gerontology
• Psychiatry
• Health Services Research

Background:

• Depression affects up to 20% of older adults, leading to poorer health outcomes.
• It is often under-diagnosed and under-treated in this population.
• Barriers include patient reluctance to discuss mood and limited GP consultation time/referral options.

Purpose of the Study:

• To explore patient and professional views on a collaborative care model for older adults with depression.
• To assess the feasibility of implementing this model at scale.

Main Methods:

• A qualitative study nested within the CASPER plus (Care for Screen Positive Elders) randomised controlled trial.
• Interviews were conducted with 33 patient participants, general practitioners (GPs), and case managers (CMs).
• Thematic analysis was performed using Normalization Process Theory.

Main Results:

• Four themes emerged: understanding of collaborative care, patient-professional interaction, GP-CM liaison, and implementation potential.
• Telephone-delivered behavioral activation is acceptable and deliverable by CMs.
• The collaborative care framework is logical for CMs and can optimize outcomes.

Conclusions:

• The CASPER plus model, using telephone-delivered therapy, is a viable option for resource-poor health services.
• Successful implementation requires integration into general practice and improved GP understanding of collaborative care.
• Enhanced liaison between GPs and CMs can facilitate patient support and intervention delivery.