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Understanding and Navigating the Unique Barriers Rural Primary Care Settings Face when Implementing Collaborative

Elizabeth J Austin1, Elsa S Briggs2, Angel Cheung3

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Implementing the Collaborative Care Model (CoCM) in rural primary care (RPC) settings presents unique challenges. Strategies tailored to RPC contexts can overcome barriers like the COVID-19 pandemic and staff availability.

Keywords:
Implementation supportsIntegrated careRural primary care

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Area of Science:

  • Healthcare Management
  • Primary Care Research
  • Implementation Science

Background:

  • Rural primary care (RPC) clinics encounter distinct obstacles when adopting the Collaborative Care Model (CoCM). Understanding these challenges is crucial for successful integration.
  • The Collaborative Care Model (CoCM) is an evidence-based approach to integrating mental health care into primary care settings.

Purpose of the Study:

  • To explore the perspectives of rural primary care staff and practice facilitators (PFs) regarding barriers and facilitators to CoCM implementation.
  • To identify context-specific strategies for overcoming implementation challenges in RPC settings.

Main Methods:

  • A mixed-methods approach combining quantitative survey data from 459 surveys across 23 clinics and qualitative interviews with 11 clinic staff and PFs.
  • Quantitative data from practice facilitators' monthly reports on barriers and facilitators were analyzed descriptively.
  • Qualitative data from semi-structured interviews were analyzed using the Rapid Assessment Process and triangulated with quantitative findings.

Main Results:

  • The most significant barriers identified were the COVID-19 pandemic, limited site staff availability for implementation activities, and the hiring of new CoCM staff.
  • Qualitative data provided nuanced insights into how these barriers specifically impacted RPC settings.
  • Practice facilitators reported on barriers and facilitators across 459 clinic interactions.

Conclusions:

  • Rural primary care settings face unique implementation barriers to the Collaborative Care Model.
  • Tailored implementation strategies are essential for the successful adoption of CoCM in RPC environments.
  • Addressing challenges such as pandemic disruptions, staff engagement, and workforce changes is key to advancing CoCM in rural healthcare.