Integrated collaborative care model for common mental disorders: an implementation study on a pilot in France with a mixed approach

Background: The Collaborative Care Model (CoCM) for the care of common mental disorders in primary care is an evidence-based integrated care model, including the service user, her/his general practitioner (GP), a care manager (CM) and a remote psychiatrist in a collaborative team.

 

Approach:In 2021-2023, a CoCM was deployed for the first time in France in four primary care practices with different organisations (multidisciplinary group practices/solo GPs) in contrasted geographical areas (rural/urban, different socio-economic environments). Nurses with previous professional experience in hospital psychiatry acted as CM in the practices.

 

An implementation study, funded by the Ministry of Health, was conducted on this pilot, to assess the eight Proctor’s implementation outcomes, with a mixed methods approach, i.e. relying on quantitative (from electronic medical records or online questionnaires) and qualitative methodology (interviews with service users and professionals). The presentation will focus on fidelity and Lyon’s perceptual implementation outcomes (acceptability, appropriateness and feasibility) of such integrated care.

 

Results: Among the 608 CoCM service users, 235 gave their consent for use of their data in the quantitative study, 9 responded to a qualitative study and 121 to questionnaire (response rate 52%). The entire 22 professionals (16 GPs, 3 CM, 3 psychiatrists) participated over a period of three years in a qualitative study (N=72 interviews) and 86% to questionnaires.

For patient experiences, four dimensions emerged from qualitative and quantitative findings: 1) increased understanding of mental disorders and care, 2) facilitated access to care, 3) feeling supported by a integrated team with a major role of their GP and the CM and 4) playing an active role in their recovery process.

 

The study of professional experiences highlighted high satisfaction scores and three main dimensions: 1) facilitating factors over time: interprofessional dynamic values, pivotal role of the CM, psychiatric support gradually institutionalised in terms of arbitration of more complex situations, rapid free and non-stigmatized care facilitating, 2) areas of adaptation: clarification of each role, inclusion criteria and the teams's operating proceduresand 3) vulnerability issues: “shift in tasks” or “buffer” roles for CM, some misappropriation of the model or alert points of attention as technical limitations.

The profile of patients, the care provided and outcomes tended, at the four sites, to match the original CoCM and others international implementations, in terms of early intervention, intensive care, and type of care delivered by CM. It was adapted to the initial symptom severity in line with a stepped-care approach. Higher fidelity of the CM intervention to the CoCM was associated with better patient outcomes.

 

Implications: This research provides some suggestions for the ongoing scaling up the CoCM model of integrated care for common mental disorders. It has been underway following the pilot with 22 primary care practices and eight CMs in the Ile-de-France region, in the frame of Article 51 of the Social Security Financing Law, which provides a consolidated budget to support innovative care models in the health sector. For example, the preliminary and continuous training for CMs and professionals and the necessary organizational support.