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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