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Implementing collaborative care for older people with comorbid hypertension and depression in rural China

Published online by Cambridge University Press:  21 October 2019

Lydia W. Li ,
Jiang Xue Open the ORCID record for Jiang Xue [Opens in a new window] ,
Yeates Conwell Open the ORCID record for Yeates Conwell [Opens in a new window] ,
Qing Yang  and
Shulin Chen
Lydia W. Li*
Affiliation:
School of Social Work, University of Michigan, Ann Arbor, MI, USA
Jiang Xue
Affiliation:
Department of Psychology, Zhejiang University, Zhejiang Province, China
Yeates Conwell
Affiliation:
Department of Psychiatry, University of Rochester, Rochester, NY, USA
Qing Yang
Affiliation:
School of Public Health, Zhejiang University, Zhejiang Province, China
Shulin Chen
Affiliation:
Department of Psychology, Zhejiang University, Zhejiang Province, China
*
Correspondence should be addressed to: Lydia W. Li, School of Social Work, University of Michigan, 1080 S. University, Ann Arbor, MI 48109-1106, USA. Phone: +1 734 936 4850, Fax: +1 734 763-3372. Email: lydiali@umich.edu.
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Abstract

Background:

Depression often coexists with other chronic conditions in older people. The COACH study is an ongoing random controlled trial (RCT) to test the effectiveness of a primary-care-based collaborative care approach to treat co-morbid hypertension and depression in Chinese rural elders. In the COACH model, a team—village doctor (VD), aging worker (AW), and psychiatrist consultant—provides collaborative care to enrolled subjects in each intervention village for 12 months. This study examines how COACH was implemented and identifies facilitators and barriers for its more widespread implementation.

Methods:

Five focus groups were conducted, two with VDs, two with AWs, and one with psychiatrists, for a total of 38 participants. Transcripts were analyzed using qualitative content analysis.

Results:

COACH care-team members showed shared understanding and appreciation of the team approach and integrated management of hypertension and depression. Team collaboration was smooth. All members regarded COACH to be effective in reducing depressive symptoms and improving patient health. Facilitators to implementation include training, leaders’ support, geographic proximity between VD and AW pairs, preexisting relationships among care-team members, comparability of COACH activities and existing practices of VDs and AWs, and care team members’ caring about older members of their villages. Barriers to sustainability include frustration of some VDs related to their low wages and feelings of overload of some AWs.

Conclusions:

COACH was positively perceived and successfully implemented. The findings offer guidance for planning primary-care-based collaborative depression care in low- and middle-income countries.

Keywords

integrated carebehavioral health in primary care settingsmental-health-care accessLMICs
Type
Original Research Article
Information
International Psychogeriatrics , Volume 32 , Special Issue 12: Issue Theme: Implementation Science , December 2020 , pp. 1457 - 1465
Copyright
© International Psychogeriatric Association 2019

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