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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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References

Archer, J. et al. (2012). Collaborative care for depression and anxiety problems. Cochrane Database System Review, 10, Cd006525.Google ScholarPubMed
Chen, S. et al. (2018). Protocol of an ongoing randomized controlled trial of care management for comorbid depression and hypertension: the Chinese Older Adult Collaborations in Health (COACH) study. BMC Geriatrics, 18, 124.CrossRefGoogle ScholarPubMed
Chobanian, A.V. et al. (2003). The seventh report of the joint national committee on prevention, detection, evaluation, and treatment of high blood pressure: the JNC 7 report. JAMA, 289, 2560–2572.CrossRefGoogle ScholarPubMed
Ciechanowski, P. et al. (2004). Community-integrated home-based depression treatment in older adults: a randomized controlled trial. JAMA, 291, 1569–1577.CrossRefGoogle ScholarPubMed
Ho, C., Feng, L., Fam, J., Mahendran, R., Kua, E.H. and Ng, T.P. (2014). Coexisting medical comorbidity and depression: multiplicative effects on health outcomes in older adults. International Psychogeriatrics, 26, 1221–1229.CrossRefGoogle ScholarPubMed
Komaromy, M. et al. (2016). Project ECHO (Extension for Community Healthcare Outcomes): a new model for educating primary care providers about treatment of substance use disorders. Substance Abuse, 37, 20–24.CrossRefGoogle ScholarPubMed
Krousel-Wood, M.A. and Frohlich, E.D. (2010). Hypertension and depression: coexisting barriers to medication adherence. Journal of Clinical Hypertension, 12, 481–486.Google ScholarPubMed
Li, Z., Li, Y., Chen, L., Chen, P. and Hu, Y. (2015). Prevalence of depression in patients with hypertension: a systematic review and meta-analysis. Medicine, 94, e1317.CrossRefGoogle ScholarPubMed
Liu, L.S. (2011). 2010 Chinese guidelines for the management of hypertension. Zhonghua xin xue guan bing za zhi, 39, 579–615.Google ScholarPubMed
May, C. and Finch, T. (2009). Implementing, embedding, and integrating practices: an outline of normalization process theory. Sociology, 43, 535–554.CrossRefGoogle Scholar
Moussavi, S., Chatterji, S., Verdes, E., Tandon, A., Patel, V. and Ustun, B. (2007). Depression, chronic diseases, and decrements in health: results from the World Health Surveys. Lancet, 370, 851–858.CrossRefGoogle ScholarPubMed
Overbeck, G., Davidsen, A.S. and Kousgaard, M.B. (2016). Enablers and barriers to implementing collaborative care for anxiety and depression: a systematic qualitative review. Implementation Science, 11, 165.CrossRefGoogle ScholarPubMed
Patel, V. and Hanlon, C. (2018). Where There Is No Psychiatrist: A Mental Health Care Manual. Cambridge: Royal College of Psychiatrists.Google Scholar
Ramos-Rios, R., Mateos, R., Lojo, D., Conn, D.K. and Patterson, T. (2012). Telepsychogeriatrics: a new horizon in the care of mental health problems in the elderly. International Psychogeriatrics, 24, 1708–1724.CrossRefGoogle ScholarPubMed
Rubio-Guerra, A.F., Rodriguez-Lopez, L., Vargas-Ayala, G., Huerta-Ramirez, S., Serna, D.C. and Lozano-Nuevo, J.J. (2013). Depression increases the risk for uncontrolled hypertension. Experimental and Clinical Cardiology, 18, 10–12.Google ScholarPubMed
Sandstrom, Y.K., Ljunggren, G., Wandell, P., Wahlstrom, L. and Carlsson, A.C. (2016). Psychiatric comorbidities in patients with hypertension—a study of registered diagnoses 2009-2013 in the total population in Stockholm County, Sweden. Journal of Hypertension, 34, 414–420; discussion 420.CrossRefGoogle ScholarPubMed
Scalco, A.Z., Scalco, M.Z., Azul, J.B. and Lotufo Neto, F. (2005). Hypertension and depression. Clinics (Sao Paulo), 60, 241–250.CrossRefGoogle ScholarPubMed
Scherrer, J.F. et al. (2003). A twin study of depression symptoms, hypertension, and heart disease in middle-aged men. Psychosomatic Medicine, 65, 548–557.CrossRefGoogle ScholarPubMed
The Lancet. (2015). Mental health in China: what will be achieved by 2020? The Lancet, 385, 2548.CrossRefGoogle Scholar
Tse, S., Ran, M.S., Huang, Y. and Zhu, S. (2013). Mental health care reforms in Asia: the urgency of now: building a recovery-oriented, community mental health service in China. Psychiatric Services, 64, 613–616.CrossRefGoogle ScholarPubMed
Unutzer, J. et al. (2002). Collaborative care management of late-life depression in the primary care setting: a randomized controlled trial. JAMA, 288, 2836–2845.CrossRefGoogle ScholarPubMed
Unutzer, J. et al. (2008). Long-term cost effects of collaborative care for late-life depression. American Journal of Managed Care, 14, 95–100.Google ScholarPubMed
von Humboldt, S. (2016). Demographic change: an aging world. In: von Humboldt, Conceptual and Methodological Issues on the Adjustment to Aging (pp. 1–19). Dordrecht: Springer.Google Scholar
Wagstaff, A., Yip, W., Lindelow, M. and Hsiao, W.C. (2009). China’s health system and its reform: a review of recent studies. Health Economics, 18, S7–S23.CrossRefGoogle ScholarPubMed
Wang, P.S., Bohn, R.L., Knight, E., Glynn, R.J., Mogun, H. and Avorn, J. (2002). Noncompliance with antihypertensive medications: the impact of depressive symptoms and psychosocial factors. Journal of General Internal Medicine, 17, 504–511.CrossRefGoogle ScholarPubMed
Wilberforce, M., Tucker, S., Abendstern, M., Brand, C., Giebel, C.M. and Challis, D. (2013). Membership and management: structures of inter-professional working in community mental health teams for older people in England. International Psychogeriatrics, 25, 1485–1492.CrossRefGoogle ScholarPubMed
Wood, E., Ohlsen, S. and Ricketts, T. (2017). What are the barriers and facilitators to implementing collaborative care for depression? A systematic review. Journal of Affective Disorders, 214, 26–43.CrossRefGoogle ScholarPubMed
Zhang, J., Ye, M., Huang, H., Li, L. and Yang, A. (2008). Depression of chronic medical inpatients in China. Archives of Psychiatric Nursing, 22, 39–49.CrossRefGoogle ScholarPubMed