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Original research
Implementation of care managers for patients with depression: a cross-sectional study in Swedish primary care
  1. Pia Augustsson1,2,
  2. Anna Holst1,2,
  3. Irene Svenningsson1,2,
  4. Eva-Lisa Petersson1,2,
  5. Cecilia Björkelund1,2,
  6. Elisabeth Björk Brämberg1,2,3
  1. 1Primary Health Care, School of Public Health and Community Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
  2. 2Research and Development, Primary Health Care, Region Västra Götaland, Sweden
  3. 3Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden
  1. Correspondence to Pia Augustsson; pia.augustsson_olsson{at}


Objectives To perform an analysis of collaborative care with a care manager implementation in a primary healthcare setting. The study has a twofold aim: (1) to examine clinicians’ and directors’ perceptions of implementing collaborative care with a care manager for patients with depression at the primary care centre (PCC), and (2) to identify barriers and facilitators that influenced this implementation.

Design A cross-sectional study was performed in 2016–2017 in parallel with a cluster-randomised controlled trial.

Setting 36 PCCs in south-west Sweden.

Participants PCCs’ directors and clinicians.

Outcome Data regarding the study’s aims were collected by two web-based questionnaires (directors, clinicians). Descriptive statistics and qualitative content analysis were used for analysis.

Results Among the 36 PCCs, 461 (59%) clinicians and 36 (100%) directors participated. Fifty-two per cent of clinicians could cooperate with the care manager without problems. Forty per cent regarded to their knowledge of the care manager assignment as insufficient. Around two-thirds perceived that collaborating with the care manager was part of their duty as PCC staff. Almost 90% of the PCCs’ directors considered that the assignment of the care manager was clearly designed, around 70% considered the priority of the implementation to be high and around 90% were positive to the implementation. Facilitators consisted of support from colleagues and directors, cooperative skills and positive attitudes. Barriers were high workload, shortage of staff and extensive requirements and demands from healthcare management.

Conclusions Our study confirms that the care manager puts collaborative care into practice. Facilitators and barriers of the implementation, such as time, information, soft values and attitudes, financial structure need to be considered when implementing care managers at PCCs.

  • depression & mood disorders
  • organisation of health services
  • primary care

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  • Contributors PA recruited participants and collected the data. PA and AH analysed the data and wrote the majority of the paper. IS, CB, EBB and ELP designed the study and wrote the paper. IS, CB, ELP and EBB were the trial managers, supervised the data collection and interpreted the data. All authors have extensive training and experience in conducting cross-sectional research. All authors read and approved the final version of the manuscript.

  • Funding This work was supported by the Västra Götaland Region of Sweden, Grant number: VGFOUREG-856661. The study sponsor had no role in the collection, analysis, interpretation of data or writing of the report or the decision to submit the article for publication. All authors were independent from the funder.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study was approved by the Regional ethical review board in Gothenburg (diary number: 2016 / T403-15 ad 903-13). The participants were, in the invitation email, informed that the participation was voluntary and that the participants could at any time withdraw their consent to participation without giving any reason. Participants consented to participation by submitting the questionnaire.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request. Inquiries for data access should be sent to University of Gothenburg, Sahlgrenska Academy, Institute of Medicine, School of Public Health and Community Medicine/ Primary Health Care, Box 454, 405 30 Gothenburg, Sweden, or the author Cecilia Björkelund, who will then contact the Swedish Ethical Review Authority for permission to openly share the data.

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