A collaborative care package for depression comorbid with chronic physical conditions in South Africa

Inge Petersen; One Selohilwe; Daniella Georgeu-Pepper; Christy-Joy Ras; Babalwa Zani; Ruwayda Petrus; Lauren Anderson; Ntokozo Mntambo; Tasneem Kathree; Arvin Bhana; Graham Thornicroft; Lara Fairall

doi:10.1186/s12913-022-08874-7

A collaborative care package for depression comorbid with chronic physical conditions in South Africa

Inge Petersen, One Selohilwe, Daniella Georgeu-Pepper, Christy-Joy Ras, Babalwa Zani, Ruwayda Petrus, Lauren Anderson, Ntokozo Mntambo, Tasneem Kathree, Arvin Bhana, Graham Thornicroft, Lara Fairall

Research output: Contribution to journal › Article › peer-review

Abstract

INTRODUCTION: A task-sharing collaborative care model for integrated depression care for South Africa's burgeoning primary health care population with chronic conditions was developed and tested through two pragmatic cluster randomized controlled trials. One trial focused on patients with hypertension and was located in one district where a collaborative care model was co-designed with district stakeholders. The other trial, focused on patients on antiretroviral treatment, was located in the same district site, with the addition of a second neighbouring district, without adaptation of the original model. This paper describes the package used to implement this model, and implementation outcomes across the two sites, and summarises lessons and challenges.

METHODS: The Template for Intervention Description and Replication (TIDieR) framework, adapted for complex health systems interventions, was used to describe components of the package. Additional elements of 'modifications made' and 'actual implementation' introduced in the 'Getting messier with TIDieR' framework, were used to describe implementation outcomes in terms of reach, adoption and implementation across the two trial districts.

RESULTS: In the absence of a co-design process to adapt the model to the context of the second site, there was less system level support for the model. Consequently, more project employed human resources were deployed to support training of primary care nurses in identification and referral of patients with depression; and supervise co-located lay counsellors. Referrals to co-located lay counselling services were more than double in the second site. However, uptake of counselling sessions was greater in the first site. This was attributed to greater in-vivo supervision and support from existing mental health specialists in the system. There was greater reliance on online supervision and support in the second site where geographical distances between clinics were larger.

CONCLUSION: The need for in-country co-designed collaborative care models, and 'implementation heavy' implementation research to understand adaptations required to accommodate varying in-country health system contexts is highlighted.

Original language	English
Pages (from-to)	1465
Journal	BMC Health Services Research
Volume	22
Issue number	1
DOIs	https://doi.org/10.1186/s12913-022-08874-7
Publication status	Published - 1 Dec 2022

Keywords

Humans
South Africa/epidemiology
Depression/epidemiology
Comorbidity
Chronic Disease
Physical Examination

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

Access to Document

10.1186/s12913-022-08874-7

Cite this

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title = "A collaborative care package for depression comorbid with chronic physical conditions in South Africa",

abstract = "INTRODUCTION: A task-sharing collaborative care model for integrated depression care for South Africa's burgeoning primary health care population with chronic conditions was developed and tested through two pragmatic cluster randomized controlled trials. One trial focused on patients with hypertension and was located in one district where a collaborative care model was co-designed with district stakeholders. The other trial, focused on patients on antiretroviral treatment, was located in the same district site, with the addition of a second neighbouring district, without adaptation of the original model. This paper describes the package used to implement this model, and implementation outcomes across the two sites, and summarises lessons and challenges.METHODS: The Template for Intervention Description and Replication (TIDieR) framework, adapted for complex health systems interventions, was used to describe components of the package. Additional elements of 'modifications made' and 'actual implementation' introduced in the 'Getting messier with TIDieR' framework, were used to describe implementation outcomes in terms of reach, adoption and implementation across the two trial districts.RESULTS: In the absence of a co-design process to adapt the model to the context of the second site, there was less system level support for the model. Consequently, more project employed human resources were deployed to support training of primary care nurses in identification and referral of patients with depression; and supervise co-located lay counsellors. Referrals to co-located lay counselling services were more than double in the second site. However, uptake of counselling sessions was greater in the first site. This was attributed to greater in-vivo supervision and support from existing mental health specialists in the system. There was greater reliance on online supervision and support in the second site where geographical distances between clinics were larger.CONCLUSION: The need for in-country co-designed collaborative care models, and 'implementation heavy' implementation research to understand adaptations required to accommodate varying in-country health system contexts is highlighted.",

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author = "Inge Petersen and One Selohilwe and Daniella Georgeu-Pepper and Christy-Joy Ras and Babalwa Zani and Ruwayda Petrus and Lauren Anderson and Ntokozo Mntambo and Tasneem Kathree and Arvin Bhana and Graham Thornicroft and Lara Fairall",

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T1 - A collaborative care package for depression comorbid with chronic physical conditions in South Africa

AU - Petersen, Inge

AU - Selohilwe, One

AU - Georgeu-Pepper, Daniella

AU - Ras, Christy-Joy

AU - Zani, Babalwa

AU - Petrus, Ruwayda

AU - Anderson, Lauren

AU - Mntambo, Ntokozo

AU - Kathree, Tasneem

AU - Bhana, Arvin

AU - Thornicroft, Graham

AU - Fairall, Lara

PY - 2022/12/1

Y1 - 2022/12/1

N2 - INTRODUCTION: A task-sharing collaborative care model for integrated depression care for South Africa's burgeoning primary health care population with chronic conditions was developed and tested through two pragmatic cluster randomized controlled trials. One trial focused on patients with hypertension and was located in one district where a collaborative care model was co-designed with district stakeholders. The other trial, focused on patients on antiretroviral treatment, was located in the same district site, with the addition of a second neighbouring district, without adaptation of the original model. This paper describes the package used to implement this model, and implementation outcomes across the two sites, and summarises lessons and challenges.METHODS: The Template for Intervention Description and Replication (TIDieR) framework, adapted for complex health systems interventions, was used to describe components of the package. Additional elements of 'modifications made' and 'actual implementation' introduced in the 'Getting messier with TIDieR' framework, were used to describe implementation outcomes in terms of reach, adoption and implementation across the two trial districts.RESULTS: In the absence of a co-design process to adapt the model to the context of the second site, there was less system level support for the model. Consequently, more project employed human resources were deployed to support training of primary care nurses in identification and referral of patients with depression; and supervise co-located lay counsellors. Referrals to co-located lay counselling services were more than double in the second site. However, uptake of counselling sessions was greater in the first site. This was attributed to greater in-vivo supervision and support from existing mental health specialists in the system. There was greater reliance on online supervision and support in the second site where geographical distances between clinics were larger.CONCLUSION: The need for in-country co-designed collaborative care models, and 'implementation heavy' implementation research to understand adaptations required to accommodate varying in-country health system contexts is highlighted.

AB - INTRODUCTION: A task-sharing collaborative care model for integrated depression care for South Africa's burgeoning primary health care population with chronic conditions was developed and tested through two pragmatic cluster randomized controlled trials. One trial focused on patients with hypertension and was located in one district where a collaborative care model was co-designed with district stakeholders. The other trial, focused on patients on antiretroviral treatment, was located in the same district site, with the addition of a second neighbouring district, without adaptation of the original model. This paper describes the package used to implement this model, and implementation outcomes across the two sites, and summarises lessons and challenges.METHODS: The Template for Intervention Description and Replication (TIDieR) framework, adapted for complex health systems interventions, was used to describe components of the package. Additional elements of 'modifications made' and 'actual implementation' introduced in the 'Getting messier with TIDieR' framework, were used to describe implementation outcomes in terms of reach, adoption and implementation across the two trial districts.RESULTS: In the absence of a co-design process to adapt the model to the context of the second site, there was less system level support for the model. Consequently, more project employed human resources were deployed to support training of primary care nurses in identification and referral of patients with depression; and supervise co-located lay counsellors. Referrals to co-located lay counselling services were more than double in the second site. However, uptake of counselling sessions was greater in the first site. This was attributed to greater in-vivo supervision and support from existing mental health specialists in the system. There was greater reliance on online supervision and support in the second site where geographical distances between clinics were larger.CONCLUSION: The need for in-country co-designed collaborative care models, and 'implementation heavy' implementation research to understand adaptations required to accommodate varying in-country health system contexts is highlighted.

KW - Humans

KW - South Africa/epidemiology

KW - Depression/epidemiology

KW - Comorbidity

KW - Chronic Disease

KW - Physical Examination

U2 - 10.1186/s12913-022-08874-7

DO - 10.1186/s12913-022-08874-7

M3 - Article

C2 - 36457094

SN - 1472-6963

VL - 22

SP - 1465

JO - BMC Health Services Research

JF - BMC Health Services Research

IS - 1

ER -

A collaborative care package for depression comorbid with chronic physical conditions in South Africa

Abstract

Keywords

UN SDGs

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Cite this