Barriers and facilitators to implementing a technology-enhanced psychiatric collaborative care model among rural primary care sites: a mixed-methods implementation case study.
Background: Psychiatric collaborative care management (CoCM) has potential to mitigate the challenges rural communities face accessing behavioral health (BH) services. However, implementation of CoCM in rural clinics has proved difficult and may benefit from a tailored approach. This study examines...
| Publicado en: | BMC Primary Care Vol. 26; no. 1; pp. 1 - 19 |
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| Autores principales: | , , , , , , |
| Formato: | research tables/charts Journal Article |
| Publicado: |
BioMed Central
5/20/2025
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=185280360&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 185280360 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 27314553 MZZU jtl: BMC Primary Care issn: 27314553 maglogo: N pubinfo: dt: 5/20/2025 vid: 26 iid: 1 pid: 24147 pub: BioMed Central artinfo: ui: 185280360 185280360 185280360 10.1186/s12875-025-02839-5 185280360 ppf: 1 ppct: 18 formats: tig: atl: Barriers and facilitators to implementing a technology-enhanced psychiatric collaborative care model among rural primary care sites: a mixed-methods implementation case study. aug: au: Kruis, Ryan Johnson, Emily Guille, Constance Sprouse-McClam, Candace Alkis, Andrew McElligott, James Harvey, Jillian affil: Manatt Health Strategies, Chicago, IL, USA sug: subj: Telepsychiatry Primary Health Care Rural Health Services Mental Disorders Therapy Health Services Accessibility Evaluation Implementation Science Psychiatric Service Collaboration Human South Carolina Funding Source Male Female Adult Middle Age Aged Multimethod Studies Case Studies Surveys Focus Groups Interviews Workflow Feedback Job Satisfaction Psychiatric Patients Needs Assessment Adult: 19-44 years Middle Aged: 45-64 years Aged: 65+ years Male Female ab: Background: Psychiatric collaborative care management (CoCM) has potential to mitigate the challenges rural communities face accessing behavioral health (BH) services. However, implementation of CoCM in rural clinics has proved difficult and may benefit from a tailored approach. This study examines implementation of a telehealth-enabled CoCM program in four rural South Carolina clinics guided by the Dynamic Adaptation Process (DAP), with particular focus on identifying barriers, facilitators, and strategies to support implementation. Methods: This study used a mixed-methods, embedded, chronological case study approach, integrating several data sources collected longitudinally during implementation. Data included surveys, focus groups, key informant interviews, and administrative data. Data were integrated using a weaving approach to develop summaries of each of the DAP phases of program implementation (Exploration, Preparation, Implementation, Sustainment). Results: Initial Exploration implementation activities included workflow development, telehealth platform configuration, building the CoCM provider team, and conducting an assessment among implementation clinics. Scarcity of BH resources was the primary barrier to rural BH treatment, leading to strong anticipated fit of the CoCM pilot among providers. These data informed activities and adaptations in subsequent phases. During the Preparation phase, the CoCM team was trained and site visits were conducted by the remote care manager to build rapport with clinic staff. In Implementation, the pilot launched, receiving 296 referrals and 99 patient enrollments in the first eight months. Post-implementation feedback showed strong provider satisfaction. Patient need, patient interest, and provider engagement with the care manager were identified as the primary facilitators for referral. During the Sustainment phase, workflow, technology, and auditing process improvements took place alongside planning for future program expansion. Conclusionl: The DAP shows great utility for tailoring implementation of CoCM to specific rural settings by providing a roadmap for identifying contextual barriers and facilitators that can be addressed through adaptation and other implementation strategies. pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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