Newly educated care managers' experiences of providing care for persons with stress-related mental disorders in the clinical primary care context

Next stop - mental health: a qualitative study of healthcare journeys from the perspective of young adults in Sweden

BACKGROUND

Help-seeking for mental health problems is a complex process that involves handling both personal challenges and dealing with the organizational structure of the healthcare system. The healthcare system is siloed and fragmented, but it is unclear how the challenges are experienced by the young adults and what their healthcare journeys look like. Therefore, the aim of this study was to explore experiences of young adults' healthcare journeys in the context of help-seeking for common mental health problems.

METHODS

In total, 25 young adults (16 women and 9 men) from a student healthcare centre at a Swedish university seeking help for common mental health problems, such as anxiety and depression, were interviewed. A qualitative thematic analysis with an inductive approach was done, and results were abstracted and presented in terms of journey-related metaphors.

RESULTS

The healthcare journeys of young adults were described as Taxi Riding, Commuting, Sightseeing, and Backpacking. Taxi riding and Commuting are defined by going in a straightforward and smooth way in the healthcare system, without major obstacles to care. In contrast, Sightseeing and Backpacking are characterized by more diffuse and negative experiences, where the young adults are not satisfied with the help received from healthcare providers. Help-seeking is not conformant with the design of the healthcare system but steered by a range of factors, including individual experiences and young adults' agency, the available resources at the various healthcare providers, and interaction with healthcare professionals.

CONCLUSIONS

Young adults' healthcare journeys in the context of help-seeking for common mental health problems are related to individual, relational, and organizational factors. Some journeys run smoothly, epitomizing a functioning healthcare system that accommodates a rational help-seeker. Other journeys depict a rigid healthcare system, where the success and nature of the journey primarily depend on individual agency and on not becoming discouraged by obstacles. There is a need for more knowledge on how to support young adults' mental health help-seeking. However, we also need more insights into how the healthcare system can become more receptive and accommodating toward the needs of young adults with common mental health problems.

GPs' experiences of a collaborative care model for patients with common mental disorders who need sick leave certification: a qualitative study

BACKGROUND

GPs are an important part of collaboration around patients with common mental disorders (CMD) in primary care. The Co-Work-Care model was implemented to further improve collaboration, and emphasised working more closely with patients through active dialogues among care managers, rehabilitation coordinators, and GPs. This enhanced collaborative model also included a person-centred dialogue meeting with patients' employers.

AIM

The aim of this study was to explore GPs' experiences of the Co-Work-Care model, an organisation of collaborative care at the primary care centre (PCC) that includes a person-centred dialogue meeting in the care of patients with CMD who need sick leave certification.

DESIGN & SETTING

Qualitative individual and group interviews were conducted with Swedish GPs with experience of the Co-Work-Care trial where the PCC was an intervention PCC with the enhanced collaboration model.

METHOD

GPs were sampled purposefully from different Co-Work-Care intervention PCCs in Sweden. Focus group and individual, in-depth semi-structured interviews were conducted. All interviews were analysed by systematic text condensation (STC), according to Malterud.

RESULTS

The following three codes describing the GPs' experiences of working in the Co-Work-Care model were identified: (1) a structured work approach; (2) competency of the care manager and the rehabilitation coordinator; and (3) gaining control through close collaboration.

CONCLUSION

Overall, GPs' experience was that the enhanced collaboration reduced their workload and enabled them to focus on medical care. Patient care was perceived as safer and more effective. These advantages may result in higher quality in medical and rehabilitation decisions, as well as a more sustainable and less stressful work situation for GPs.

The care manager meeting the patients' unique needs using the care manager model-A qualitative study of experienced care managers

Background

Implementation of a care manager in a collaborative care team in Swedish primary care via a randomized controlled trial showed successful outcome. As four years have elapsed since the implementation of care managers, it is important to gain knowledge about the care managers’ long-term skills and experiences. The purpose was to examine how long-term experienced care managers perceived and experienced their role and how they related to and applied the care manager model.

Method

Qualitative study with a focus group and interviews with nine nurses who had worked for more than two years as care managers for common mental disorders. The analysis used Systematic Text Condensation.

Results

Four codes arose from the analysis: Person-centred; Acting outside the comfort zone; Successful, albeit some difficulties; Pride and satisfaction. The care manager model served as a handrail for the care manager, providing a trustful and safe environment. Difficulties sometimes arose in the collaboration with other professionals.

Conclusion

This study shows that long-term experience of working as a care manager contributed to an in-depth insight and understanding of the care manager model and enabled care managers to be flexible and act outside the comfort zone when providing care and support to the patient. A new concept emerged during the analytical process, i.e. the Anchored Care Manager, which described the special competencies gained through experience.

Trial registration

NCT02378272 Care Manager—Coordinating Care for Person Centered Management of Depression in Primary Care (PRIM—CARE).

Associations between antidepressant therapy, work ability, and sick leave for patients with common mental disorders within a two-year perspective - A longitudinal observational cohort study in Swedish primary care

Background

An increasing number of patients are on sick leave because of common mental disorders (CMD), with or without antidepressant therapy. There is a lack of long-term follow-up studies in the primary care context, where most of the patients are treated. The importance of identifying potential factors associated with work ability for CMD patients is increasingly in focus.

Objective

To investigate the associations between using antidepressants, sick leave duration, reported work ability and psychological symptoms among patients with CMD during a two-year observation period in the primary care context.

Methods

Longitudinal observational cohort study at 28 Primary Care Centers in Region Västra Götaland, Sweden, including 182 patients with an employment and on sick leave for CMD. The following outcomes were assessed: work ability measured with WAI, depressive symptoms with MADRS-S, anxiety symptoms with BAI, fatigue symptoms with KEDS, quality of life with EQ-5D, and days of sick leave. The data were compared between the groups that used and did not use antidepressants, during the 24-months observation period.

Results

Work ability and health-related quality of life increased over time in both groups. A steeper decrease of depressive symptoms, anxiety symptoms as well as an increased health-related quality of life at 3, 6 and 12 months was found in the group without antidepressants, although both groups levelled off at 24 months. In both groups, a higher work ability at baseline was associated with less two-year sick leave.

Conclusion

Our study indicates that a high work ability at baseline has a strong association with a lower total net and gross sick leave duration during the entire two-year follow-up period for patients with CMD in primary health care, irrespective of use of antidepressants. Using WAI in primary health care could therefore be helpful in predicting return to work. Use of antidepressants during the CMD episode could indicate initially a more pronounced overall symptom pattern, motivating introduction of antidepressants, rather than prolonging the sick leave period.