Programme no. 241-OP
Which professional competences make collaborative care work? A study of GPs’, psychiatric nurses’ and psychiatrists’ views
Gritt Overbeck*1, Annette Sofie Davidsen2
1Research Unit for General Practice,Copenhagen,Denmark, 2Research Unit for General Practice,Copenhagen,Denmark
* = Presenting author
Objectives: To investigate which professional competences GP’s, psychiatrists and psychiatric nurses regard as central for making a collaborative care model work in practice.
Background: Patients with depression and anxiety disorders are treated mainly in primary care. Studies from the US and the UK have shown that collaborative care - a close collaboration between primary and secondary care, normally with psychiatric care managers working in primary care - has a greater effect than routine care. From 2014-2017 a collaborative care study for patients with anxiety and depression will be carried out in four regions in Denmark. The study will include 80 GPs and approximately 2.000 patients. Literature suggests that the actors’ propensity to buy-in is crucial for making the model work. And that buying-in, especially for the GP’s, is dependent on their conviction that care managers have adequate skills.
Results: Data collection is still in progress. Preliminary results show that the actors regard two types of professional competences as central for making the model work: 1) knowledge of disease and therapeutic skills and 2) Collaboration competences. However, the three groups seem to have slightly different perceptions of what the relevant knowledge and therapeutic skills are and quite different perspectives on what collaboration really consists of in this model, and how it should be pursued. GPs are ambivalent about collaboration expressing concerns that working with a care manager will be time consuming but they are enthusiastic about the possibility of getting supervision from a psychiatrist. Psychiatrists solely focus on how GPs’ enhanced access to psychiatric supervision will relieve GPs in their daily work. Neither psychiatrists nor GP’s express that care managers can be helpful for the GP. In contrast, care managers demonstrate great interest in investigating how they can support the GP and especially how they can meet the GPs’ different needs.
Material/Methods: GPs, psychiatrists, and psychiatric nurses employed as care manages are interviewed with a focus on their perceptions prior to the intervention. The data is analyzed using the framework of Normalization Process Theory (NPT), a theoretical framework for analyzing complex interventions in health care.
Conclusion: GPs, psychiatrists and care managers have different expectations especially to the content and degree of collaboration in the collaborative care model that is being studied in Denmark.
Points for discussion: How can GPs’ ambivalence towards the model be understood?; Which preconceptions determine that collaboration with care managers is viewed as time consuming and supervision from psychiatrists as a benefit?