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Table 5 Model components not consistently delivered as intended

From: Refining a model of collaborative care for people with a diagnosis of bipolar, schizophrenia or other psychoses in England: a qualitative formative evaluation

Delivered as intended Not delivered as intended
1. An underpinning conceptual model of collaboration
The PARTNERS model included manualised and planned care, a case-manager, support for self-management through coaching, making specialist mental health workers readily available to primary care workers and recording in shared records.
The CHIME framework was included as a specific focus of the intervention.
 
2. Identification of patients: method
Service users were identified from records and discussion with secondary care staff  
3. Identification of patients: setting
Service users were identified in both primary and secondary care settings.  
4. Provider integration
In two sites: In one site:
 • Care partners maintained allocated time to carry out PARTNERS role
 • Primary care services accommodated the care partner’s needs
• care partner required to return to secondary care role
• primary care services did not give care partners access to necessary resources (e.g.: rooms, access to IT)
5.Multi-disciplinary working
In one site: In all sites:
 • supervision took place routinely • limited evidence of integration into primary care teams
In all sites:
 • access to psychiatric consultation was available
In two sites:
 • supervision was not delivered consistently
6. Systematic communication between providers
In all sites: In all sites
 • a few examples of care partners making helpful entries in records, making appropriate requests to GPs and attending practice meetings • very limited evidence of recording in shared records
• very limited evidence of interaction between care partners and primary care teams
7. Case management
In all sites:
 • evidence of care partners liaising with other providers in response to goals identified by service users or change in mental health  
8. Study protocols / treatment algorithms
In all sites
 • care partners and supervisors were aware that the manual should guide care and evidence that they accessed the manual  
9. Systematic monitoring / follow up
In one site: In one site:
 • repeated measures used consistently • no evidence that repeated measures used
• lack of regular follow up by care partner
In two sites:
 • regular follow up provided
In one site:
 • repeated measures used but not in a way that was consistent with the ethos of the model
  In one site:
 • uncertainty about whether variation in intensity could include duration as well as frequency of contact
10. Pharmacological intervention
In all sites
 • evidence that this had been discussed as a possible personal goal and psychiatric consultation sought where relevant  
11. Psychological intervention
In one site: In all sites:
 • coaching approach used to a large extent • resources provided in the intervention manual to support coaching processes were rarely used
In two sites:
 • very limited evidence of coaching approach being used
12. Education for mental health / primary care providers
In all sites:
 • training provided  
13. Patient education / promoting self-management
In one site: In two sites:
 • motivational approach used to a large extent • very limited evidence of motivational approach being used
14. Shared decision making with patients
In one site In all sites:
 • collaborative style of interaction largely present between care partner and service user • service user guide intended to support service user participation not widely used
In two sites:
 • very limited evidence of a collaborative style of interaction between care partners and service users