Care managers can be useful for patients with depression but their role must be clear: a qualitative study of GPs’ experiences

Abstract

Objective: Explore general practitioners’ (GPs’) views on and experiences of working with care managers for patients treated for depression in primary care settings. Care managers are specially trained health care professionals, often specialist nurses, who coordinate care for patients with chronic diseases.

Design: Qualitative content analysis of five focus-group discussions.

Setting: Primary health care centers in the Region of Västra Götaland and Dalarna County, Sweden.

Subjects: 29 GPs.

Main outcome measures: GPs’ views and experiences of care managers for patients with depression.

Results: GPs expressed a broad variety of views and experiences. Care managers could ensure care quality while freeing GPs from case management by providing support for patients and security and relief for GPs and by coordinating patient care. GPs could also express concern about role overlap; specifically, that GPs are already care managers, that too many caregivers disrupt patient contact, and that the roles of care managers and psychotherapists seem to compete. GPs thought care managers should be assigned to patients who need them the most (e.g. patients with life difficulties or severe mental health problems). They also found that transition to a chronic care model required change, including alterations in the way GPs worked and changes that made depression treatment more like treatment for other chronic diseases.

Conclusion: GPs have varied experiences of care managers. As a complementary part of the primary health care team, care managers can be useful for patients with depression, but team members’ roles must be clear.

KEY POINTS

• A growing number of primary health care centers are introducing care managers for patients with depression, but knowledge about GPs’ experiences of this kind of collaborative care is limited.

• GPs find that care managers provide support for patients and security and relief for GPs.

• GPs are concerned about potential role overlap and desire greater latitude in deciding which patients can be assigned a care manager.

• GPs think depression can be treated using a chronic care model that includes care managers but that adjusting to the new way of working will take time.

Keywords:

• Primary care
• family medicine
• nursing interventions
• coordinated care
• psychiatry
• patient care continuity
• collaborative care

Acknowledgments

We thank the participating primary health care centers and GPs for their time and for sharing their experiences with us. We also thank Scientific Editor Kimberly Kane for useful comments on the text and for help with translating the quotations.

Ethical approval

Ethical approval for this study was obtained from the Regional Ethical Review Board in Gothenburg, Sweden (Dnr: 903-13, T403-15). The research was conducted in accordance with the World Medical Association Declaration of Helsinki of 1975, as revised in 1983.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This study was supported by Region Västra Götaland, Dalarna County Council, and by grants provided by Stockholm County Council (PPG project).