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Cited by 36Health Policy Implementation ScienceDiabetes Management and EducationPrimary Care and Health Outcomes

Contextualizing the effectiveness of a collaborative care model for primary care patients with diabetes and depression (Teamcare): a qualitative assessment using RE-AIM

Wozniak, Lisa, Soprovich, Allison, Rees, Sandra, Al Sayah, Fatima, Majumdar, Sumit R., Johnson, Jeffrey A.·2015·Canadian Journal of Diabetes
DOI 10.1016/j.jcjd.2015.05.004
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Abstract

Objective We evaluated the implementation of an efficacious collaborative care model for patients with diabetes and depression in a controlled trial in 4 community-based primary care networks (PCNs) in Alberta, Canada. Similar to previous randomized trials, the nurse care manager-led TeamCare intervention demonstrated statistically significant improvements in depressive symptoms compared with usual care. We contextualized TeamCare's effectiveness by describing implementation fidelity at the organizational and patient levels.Methods We used the Reach, Effectiveness, Adoption, Implementation and Maintenance (RE-AIM) framework to evaluate TeamCare. Qualitative methods used to collect data regarding the RE-AIM dimensions of Implementation and Effectiveness included interviews with PCN staff and specialists (n=36), research team reflections (n=4) and systematic documentation. We used content analysis, and Nvivo 10 for data management.Results TeamCare was implemented as intended but with suboptimal fidelity. Deviations from the model included limited degrees of collaborative care practised within the PCNs, including varying physician participation, limited comfort in practising collaborative care and discontinuity of care managers. Despite suboptimal fidelity, respondents identified several implementation facilitators at the organizational level: training, ongoing implementation support, professional and personal qualities of the care manager and pre-existing relationships. Without knowledge of the effectiveness of the intervention in our controlled trial, respondents anticipated improved patient outcomes due to the main intervention components, including active patient follow up, specialist consultation and treat-to-target principles.Conclusions Despite suboptimal implementation in Alberta's primary care context, TeamCare resulted in improved outcomes similar to those demonstrated in previous randomized trials. A stronger culture of collaborative care would likely have yielded greater implementation fidelity and possibly better outcomes.

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  • The majority of studies concerned with mental-physical comorbidity have addressed people with common mental disorders rather than severe mental illnesses.

    “The majority of the studies concerned with mental-physical comorbidity have addressed people with common mental disorders (rather than severe mental illnesses)”

    From Integrated care for people with long-term mental and physical health conditions in low-income and middle-income countries (2019) · cites this paper as [33]

  • The TeamCare trial evaluated a collaborative integrated care model for patients with diabetes and/or heart disease and depression in community-based primary care clinics in Washington State and demonstrated improved physical and mental health outcomes compared to care as usual.

    “such as the TeamCare trial which evaluated a collaborative integrated care model for patients with diabetes and/or heart disease and depression in community-based primary care clinics in Washington State and demonstrated improved physical and mental health outcomes when compared to care as usual 30-32 33”

    From Integrated care for people with long-term mental and physical health conditions in low-income and middle-income countries (2019) · cites this paper as [33]

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Authors
Wozniak, L., Soprovich, A., Rees, S., Al Sayah, F., Majumdar, S. R., & Johnson, J. A.
Affiliations
University of Alberta (CA)
Corresponding author
Johnson, Jeffrey A.
ORCID
Venue
Canadian Journal of Diabetes
Publisher
Elsevier BV
Published
2015-10
Volume
39
Pages
S83-S91
ISSN
1499-2671 (ISSN-L)
DOI
10.1016/j.jcjd.2015.05.004
OpenAlex
W2117466334
Cited by
36
References
44
Citations by year
2025: 3 · 2024: 4 · 2022: 4 · 2021: 6 · 2020: 3 · 2019: 5 · 2018: 2 · 2017: 2 · 2016: 2 · 2015: 4
FWCI
6.08
Type
journal article
Language
en
Open access
closed
Licence
Locations
  • Canadian Journal of Diabetes (publishedVersion)
  • PubMed (publishedVersion)
Funders
  • AIHS
  • Faculties of Medicine and Dentistry
  • Pharmacy and Pharmaceutical Sciences
  • Alberta Health
  • Alliance for Canadian Health Outcomes Research in Diabetes (# OTG- 88588)
  • CIHR Institute of Nutrition, Metabolism and Diabetes
Topics
  • Health Sciences › Health Professions › General Health Professions › Health Policy Implementation Science
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
  • Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
Keywords
collaborative care, diabetes mellitus, depression, nurse care managers, implementation fidelity, RE-AIM framework, primary care networks, implementation facilitators, physician participation, treat-to-target, community-based primary care
MeSH terms
Depression, Diabetes Mellitus, Type 2, Health Personnel, Humans, Models, Theoretical, Primary Health Care, Program Evaluation, Qualitative Research

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