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Table 2 Middle range theories derived from cross case analysis

From: Exposing the key functions of a complex intervention for shared care in mental health: case study of a process evaluation

   Liaison function
Discussions about individual patient cases both results in better care and forms the basis for developing an ongoing liaison relationship. The nature of the forum for the case discussion varies (telephone, routine group meeting, etc) and is context dependent.
In the absence of liaison being a policy requirement, sustained joint work requires a receptive context in both teams.
Initial analysis of the situation to agree an appropriate, context-dependent, form of liaison and subsequent review of progress are essential ingredients for successful liaison.
   Developing systems
Facilitators can only act as catalysts for developing systems in motivated and stable practices
Financial support, guidance and hands on support for developing systems from facilitators are important to practices with less IT expertise and poor systems in other areas of chronic disease management
Efforts invested by practices and facilitators to develop 'in house' IT systems for capturing mental health data and prompting best practice do not improve chronic disease management if the new systems are cumbersome or not integrated with systems for proactive review
Review of progress by external facilitators contributes to solving implementation problems
   Improved mental health care
Improvements in care at times of crisis follow liaison case discussions: these rely on the efficient identification of those to be discussed and a forum for the discussion.
In the presence of an engaged linked specialist worker and a 'working register', a regular, appropriately attended, organised forum with appropriately identified cases for shared review, can result in improved identification of unmet mental health care needs and improved care.