Barriers and facilitators to implementing a technology-enhanced psychiatric collaborative care model among rural primary care sites: a mixed-methods implementation case study
Abstract Background Psychiatric collaborative care management (CoCM) has potential to mitigate the challenges rural communities face accessing behavioral health (BH) services. However, implementation of CoCM in rural clinics has proved difficult and may benefit from a tailored approach. This study e...
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BMC
2025-05-01
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| Series: | BMC Primary Care |
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| Online Access: | https://doi.org/10.1186/s12875-025-02839-5 |
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| author | Ryan Kruis Emily Johnson Constance Guille Candace Sprouse-McClam Andrew Alkis James McElligott Jillian Harvey |
| author_facet | Ryan Kruis Emily Johnson Constance Guille Candace Sprouse-McClam Andrew Alkis James McElligott Jillian Harvey |
| author_sort | Ryan Kruis |
| collection | DOAJ |
| description | Abstract Background Psychiatric collaborative care management (CoCM) has potential to mitigate the challenges rural communities face accessing behavioral health (BH) services. However, implementation of CoCM in rural clinics has proved difficult and may benefit from a tailored approach. This study examines implementation of a telehealth-enabled CoCM program in four rural South Carolina clinics guided by the Dynamic Adaptation Process (DAP), with particular focus on identifying barriers, facilitators, and strategies to support implementation. Methods This study used a mixed-methods, embedded, chronological case study approach, integrating several data sources collected longitudinally during implementation. Data included surveys, focus groups, key informant interviews, and administrative data. Data were integrated using a weaving approach to develop summaries of each of the DAP phases of program implementation (Exploration, Preparation, Implementation, Sustainment). Results Initial Exploration implementation activities included workflow development, telehealth platform configuration, building the CoCM provider team, and conducting an assessment among implementation clinics. Scarcity of BH resources was the primary barrier to rural BH treatment, leading to strong anticipated fit of the CoCM pilot among providers. These data informed activities and adaptations in subsequent phases. During the Preparation phase, the CoCM team was trained and site visits were conducted by the remote care manager to build rapport with clinic staff. In Implementation, the pilot launched, receiving 296 referrals and 99 patient enrollments in the first eight months. Post-implementation feedback showed strong provider satisfaction. Patient need, patient interest, and provider engagement with the care manager were identified as the primary facilitators for referral. During the Sustainment phase, workflow, technology, and auditing process improvements took place alongside planning for future program expansion. Conclusionl The DAP shows great utility for tailoring implementation of CoCM to specific rural settings by providing a roadmap for identifying contextual barriers and facilitators that can be addressed through adaptation and other implementation strategies. |
| format | Article |
| id | doaj-art-e857cb5268a541cb9d09992ca9f3a4a0 |
| institution | DOAJ |
| issn | 2731-4553 |
| language | English |
| publishDate | 2025-05-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Primary Care |
| spelling | doaj-art-e857cb5268a541cb9d09992ca9f3a4a02025-08-20T03:08:43ZengBMCBMC Primary Care2731-45532025-05-0126111810.1186/s12875-025-02839-5Barriers and facilitators to implementing a technology-enhanced psychiatric collaborative care model among rural primary care sites: a mixed-methods implementation case studyRyan Kruis0Emily Johnson1Constance Guille2Candace Sprouse-McClam3Andrew Alkis4James McElligott5Jillian Harvey6Manatt Health StrategiesCollege of Nursing, Medical University of South CarolinaDepartment of Psychiatry and Behavioral Sciences, Medical University of South CarolinaManatt Health StrategiesDepartment of Psychiatry and Behavioral Sciences, Medical University of South CarolinaManatt Health StrategiesDepartment of Healthcare Leadership and Management, Medical University of South CarolinaAbstract Background Psychiatric collaborative care management (CoCM) has potential to mitigate the challenges rural communities face accessing behavioral health (BH) services. However, implementation of CoCM in rural clinics has proved difficult and may benefit from a tailored approach. This study examines implementation of a telehealth-enabled CoCM program in four rural South Carolina clinics guided by the Dynamic Adaptation Process (DAP), with particular focus on identifying barriers, facilitators, and strategies to support implementation. Methods This study used a mixed-methods, embedded, chronological case study approach, integrating several data sources collected longitudinally during implementation. Data included surveys, focus groups, key informant interviews, and administrative data. Data were integrated using a weaving approach to develop summaries of each of the DAP phases of program implementation (Exploration, Preparation, Implementation, Sustainment). Results Initial Exploration implementation activities included workflow development, telehealth platform configuration, building the CoCM provider team, and conducting an assessment among implementation clinics. Scarcity of BH resources was the primary barrier to rural BH treatment, leading to strong anticipated fit of the CoCM pilot among providers. These data informed activities and adaptations in subsequent phases. During the Preparation phase, the CoCM team was trained and site visits were conducted by the remote care manager to build rapport with clinic staff. In Implementation, the pilot launched, receiving 296 referrals and 99 patient enrollments in the first eight months. Post-implementation feedback showed strong provider satisfaction. Patient need, patient interest, and provider engagement with the care manager were identified as the primary facilitators for referral. During the Sustainment phase, workflow, technology, and auditing process improvements took place alongside planning for future program expansion. Conclusionl The DAP shows great utility for tailoring implementation of CoCM to specific rural settings by providing a roadmap for identifying contextual barriers and facilitators that can be addressed through adaptation and other implementation strategies.https://doi.org/10.1186/s12875-025-02839-5Psychiatric collaborative careIntegrated behavioral healthRural healthImplementation scienceDynamic adaptation process |
| spellingShingle | Ryan Kruis Emily Johnson Constance Guille Candace Sprouse-McClam Andrew Alkis James McElligott Jillian Harvey Barriers and facilitators to implementing a technology-enhanced psychiatric collaborative care model among rural primary care sites: a mixed-methods implementation case study BMC Primary Care Psychiatric collaborative care Integrated behavioral health Rural health Implementation science Dynamic adaptation process |
| title | Barriers and facilitators to implementing a technology-enhanced psychiatric collaborative care model among rural primary care sites: a mixed-methods implementation case study |
| title_full | Barriers and facilitators to implementing a technology-enhanced psychiatric collaborative care model among rural primary care sites: a mixed-methods implementation case study |
| title_fullStr | Barriers and facilitators to implementing a technology-enhanced psychiatric collaborative care model among rural primary care sites: a mixed-methods implementation case study |
| title_full_unstemmed | Barriers and facilitators to implementing a technology-enhanced psychiatric collaborative care model among rural primary care sites: a mixed-methods implementation case study |
| title_short | Barriers and facilitators to implementing a technology-enhanced psychiatric collaborative care model among rural primary care sites: a mixed-methods implementation case study |
| title_sort | barriers and facilitators to implementing a technology enhanced psychiatric collaborative care model among rural primary care sites a mixed methods implementation case study |
| topic | Psychiatric collaborative care Integrated behavioral health Rural health Implementation science Dynamic adaptation process |
| url | https://doi.org/10.1186/s12875-025-02839-5 |
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