Adoption of care management activities by primary care nurses for people with common mental disorders and physical conditions: A multiple case study.

WHAT IS KNOWN ON THE SUBJECT?: The collaborative care model is a well-known model to improve care quality for people with common mental disorders and physical conditions in primary care. The role of care manager is central to the collaborative care model, and primary care nurses are well-positioned to play that role. Adopting the role of care manager by primary care nurses is challenging due to several contextual factors; however, few implementation studies examined the context and current practices before implementing the role of care manager and the collaborative care model. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: The paper contributes to the advancement of knowledge about the pre-assessment of current practices before implementing the collaborative care model and the role of care manager. The paper offers a better understanding of the relationships between the context and the performance of care management activities by primary care nurses. The paper describes an innovative analysis technique to assess the gap between care management activities recommended in the collaborative care model and actual nursing activities. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Primary care nurses would benefit from having timely access to clinical support from mental health nurse practitioners in order to build their competency. Determinants of practice and the analysis technique to assess current practices will help other researchers or quality improvement teams to develop their plan when implementing the role of care manager. ABSTRACT: Introduction Few studies assessed current nursing practices before implementing the collaborative care model and the role of care manager for people with common mental disorders (CMDs) and physical conditions in primary care settings. Aim Evaluate the main determinants of practice that influence the adoption of care management activities by primary care nurses for people with CMDs and physical conditions. Methods A qualitative multiple case study was conducted in three primary care clinics. A total of 33 participants were recruited. Various data sources were combined: interviews (n = 32), nurse-patient encounters' observations (n = 7), documents and summaries of meetings with stakeholders (n = 8). Results Seven determinants were identified (1) access to external mental health resources; (2) clarification of local CMD care trajectory; (3) compatibility between the coordination of nursing work and the role of care manager; (4) availability of mental health resources within the primary care clinic; (5) competency in care management and competency building; (6) responsibility sharing between the general practitioner and the primary care nurse; and (7) common understanding of the patient treatment plan. Implications for practice To build their competency in care management for people with CMDs, primary care nurses would benefit from having clinical support from mental health nurse practitioners.