Table 4 Summary of focus group thematic analysis results
Obstacles | |
Organization | Lack of time |
Heavy workloads | |
Staff shortages | |
High staff turnover | |
Changing, unstable leadership | |
Diversity of teams | |
Multiplicity of programs and initiatives (competing demands) | |
Perceived lack of institutional buy-in | |
Health care professionals and patients | Apprehension, insecurity, lack of training/qualification among nurses |
Resistance among nurses to adopt new role | |
Resistance among patients (to be managed by a nurse) | |
Distrust of nurses’ work among doctors | |
Difficulty coordinating shared work between doctors and nurses | |
Routines, resistance to change among health care professionals | |
Implementation strategy | Top-down implementation, generating resistance among some professionals |
Lack of clarity in the definition of the care manager role | |
Limitations in training program | |
Difficulties coordinating shared care among primary care teams and psychiatry services. Compartmentalized work, not shared | |
INDI program | Complexity of the program |
Limitations in reliability of scales | |
Facilitators | |
General aspects | Prevalence and importance of depression in primary care |
Current shortcomings in management of depression and need for improvement | |
Recognition that depression should be managed by primary care | |
Implementation strategy | Useful, well-received training program |
INDI program | Recognition, reinforcement, structuring, and systematization of the role of nurses |
Systematic use of guidelines and scales to facilitate structured management | |
Greater access to and support from mental health specialists | |
Proposals | |
Healthcare institution | Clear buy-in from institution |
Actions and measures to facilitate organizational changes required | |
Inclusion of program in target payment system | |
Involvement of health care professionals implementation decisions and design | |
Stable doctor-nurse teams | |
Implementation strategy | Continued professional development for health care professionals |
Reinforcement of practical aspects of training | |
Combination of online and face-to-face training sessions | |
“Local” expert health care professionals to support teams | |
Integration of depression management into community care | |
Closer liaisons between primary care and mental health services | |
INDI program | More clearly defined roles for nurses (care managers) |
Development of a clear concept of shared care between primary care and psychiatry services | |