Patient’s perspective on the model acceptability
The acceptability of implementation was determined through patient interviews conducted both before and after their participation in the model. These interviews were conducted using a semi-structured interview guide, were digitally recorded, transcribed verbatim, then analyzed using qualitative description. Data were coded by a trained qualitative researcher (AW) according to their perceived acceptance and barriers of the collaborative care model. Prior to implementation, interviews with patients explored their preconceived notions and beliefs about depression and their individual experiences with it. For example, patients discussed their various symptoms (pain, poor memory and focus, feelings of isolation) as well as different strategies they had used to manage their own depression, such as visiting with family/friends, exercising, and going to support groups.
The MHS HIV clinic visits serve as a window of opportunity to identify and discuss depression with patients.
However, while patients seemed relatively self-aware about their own depressive symptoms and self-management techniques, they also identified the key role providers have in their mental health care.
While these patients experienced many of the common symptoms of depression, they admitted they often would not think about it or discuss it unless it was brought up by a provider. For example, one participant stated, “I don’t think I would have brought it [depressive symptoms] up if I didn’t get the little questionnaire [PHQ-2/9] when I first came to see the doctor…” This indicates that these clinic visits serve as a window of opportunity to identify and discuss depression with patients. Furthermore, in these pre-implementation interviews, patients expressed a willingness to participate in the team-based approach of collaborative care and recognized the need for the involvement of multiple providers in their mental health care. Additionally, patients appreciated the idea of having a care coordinator who could serve as a patient advocate and bridge between patient and the different providers. Overall, patients who were interviewed prior to their participation in the collaborative care model seemed aware of their depressive symptoms and own self-management strategies, yet were open and enthusiastic about the prospect of the collaborative care model.