gms | German Medical Science

Background and state of the research: Effectiveness of collaborative and stepped care models (CSC) for mental health patients is well documented and recommended by guidelines. In Germany, however, transfer to routine care has been limited. The key to overcome this gap is a comprehensive analysis of the factors influencing the successful implementation of innovative care models.

Research question and objectives, hypothesis: Aim of this study was to identify key facilitators and barriers to implementation of CSC models into routine care within the German health care setting.

Methods: For this purpose, a strengths, weaknesses, opportunities, and threats (SWOT) analysis was conducted, using a multi-step qualitative procedure: First, selected literature from 6 recently conducted German CSC trials was analyzed, extracted and categorized into SWOTs by four experienced researchers. Second, researchers of the included CSC trials discussed completeness of the SWOTs, prioritized the most important SWOTs of their project and reflected on the process within two workshops. Workshop transcripts were analyzed using content analysis. Third, extracted SWOTs of each project were compared and summarized in a differentiated SWOT matrix across projects. Evidence synthesis was conducted using an inductive-deductive approach by multiple reviewers and aligned with the 7 dimensions of the TICD-Checklist, a comprehensive, integrated checklist for identifying determinants of practice.

Results: The preliminary results of the SWOT analysis yielded in an extensive four-field matrix across projects identifying the following major themes: guideline factors, professional interactions and incentives and resources. Strengths were improved care in CSC groups (e.g., access) and reduction of barriers to inter-professional collaboration (e.g., online-appointment platform). Weaknesses related to problems with collaboration (e.g., mutual feedback), patient referrals (e.g., insufficient information), and ongoing treatment. Opportunities addressed efficient use of resources, the reduction of negative attitudes towards collaboration and further development of the intervention (e.g., inclusion of further diagnoses) while threats included lack of time and reserved, skeptical attitudes among health professionals. Final results will be presented at the conference.

Discussion: Our results revealed weaknesses and threats consistent with international research that identified health professionals’ attitudes towards change and poor inter-professional communication as barriers to be overcome. The SWOT analysis can facilitate the understanding of current and future barriers as well as facilitators and untapped opportunities of the implementation of CSC in Germany. It is crucial to accompany the effectiveness evaluation with an implementation analysis during the process, enhance reflection and to increase stakeholder involvement. More in-depth research on determinants of implementation is needed.

Implications for care: The study indicates that CSC models are promising for the treatment of mental health patients. Nonetheless, weighty barriers must be overcome in Germany to enable successful implementation in routine care.

Funding: BMBF-Strukturförderung Versorgungsforschung; 01GY1912