From: Diffusion of a collaborative care model in primary care: a longitudinal qualitative study
Primary Care Physicians (PCP) | Nurses (N) | |
---|---|---|
Common perceptions among PCPs and Nurses | ||
Observability | Positive opinion (early adopter, early majority) | Positive opinion (early adopter, early majority) |
Eg. I talked about [the CTM] a bit with one of my colleagues who has a practice much like mine, and we agreed that it could help us. PCP, early majority | Eg. We talked about [the CTM], and everyone thought that it’s a good thing. N, early adopter | |
Negative opinion (late majority, laggards) | Negative opinion (late majority, laggards) | |
Eg. We don’t hear much that is good about the networks that have been implemented. The reports aren’t very good. PCP, late adopter | Eg. My colleague will tell you exactly the same thing; (these models) are taking our jobs. N, laggard | |
Trialability | Positive opinion (early adopter, early majority) | Positive opinion (early adopter, early majority) |
Eg. I had to invest a bit of time finding [the CTM]. I tested it when I had a chance, and I found it very good. PCP, early majority | Eg. I tried [the CTM] once just to see, and it was great. So I hope it will continue. N, early majority | |
Negative opinion (late majority, laggards) | Negative opinion (late majority, laggards) | |
Eg. I proposed a patient, but I guess they didn’t quite meet their criteria… So I didn’t continue; I waited. PCP, late majority | Eg. We don’t even work the same way, we don’t have the same approach to work or availability. The first time, they said I’d find all the information there, but when I went, I saw all the faults in the system. So I said no. N, laggard | |
Simplicity | Positive opinion (early adopter, early majority) | Positive opinion (early adopter, early majority) |
Eg. It’s going well. When I call, I get a quick callback if I need [the CTM]. Right there I have my solution, right away. PCP, early adopter | Eg. [the CTM] really works very simply, (…) it’s highly available, and very responsive. It’s really easy. N, early adopter | |
Negative opinion (late majority, laggards) | Negative opinion (late majority, laggards) | |
Eg. It isn’t easy to change your practices. When we learned how to work on our own, it didn’t come easily. PCP, late adopter | Eg. It’s very unclear how it works: a [CTM] can mean anything. N, late adopter | |
Different perceptions among PCPs and Nurses | ||
Compatibility | Positive opinion but caution (early adopter, early majority) | Strong positive opinion |
Eg. To the extent that everyone knows their place and helps each other out, that we don’t start seeing encroachment by other specialists or anything like that, then [the CTM] may be a good experience. PCP, early adopter | Eg. They’re people with know-how, who don’t take over, who in fact try to respect people in their practices, to express themselves very diplomatically. N, early majority | |
Strong negative opinion (late majority, laggards) | Mild negative opinion (late majority, laggards) | |
Eg. If the case manager centralizes the information, that makes me uncomfortable. Medical information can only move from one physician to another with the patient’s agreement. PCP, laggard | Eg. I know that nowadays the style is to produce a lot of paper… We preferred spending our time with the person rather than on doing paperwork. N, laggard | |
Eg. I imagine that they’re going to impose constraints that don’t fit our practices… We don’t work the same way. So I can’t see how we can develop closer ties. PCP, laggard | ||
Eg. There are patients that I haven’t seen since. In particular, there’s a woman with dementia. She was being followed by [geriatrician], she didn’t have other needs than to see [geriatrician]. PCP, late majority | ||
Eg. When I learn that a patient I’m following has been asked to take a certain test and I learn it from a member of his family, I’ve got problems with that… PCP, laggard | ||
Eg. We’ve known our patients for years, and in a few days they’ll change the patient’s treatment without telling us. PCP, laggard | ||
Relative advantage | Mild positive opinion (early adopter, early majority) | Strong positive opinion (early adopter, early majority) |
Eg. When it comes to community-based care for dependent elderly patients, it may help. PCP, early adopter | Eg. Patient monitoring is shared. This is a great help for community-based providers, especially because it’s a multidisciplinary team that can answer quite a lot of questions. N, early majority | |
Eg. Until now, we’ve had a relationship with the attending physician of a subordinate to a higher hierarchical level. Now we have the impression that the relationship isn’t vertical, rather, it’s become more horizontal. N, early adopter | ||
Eg. As soon as there was a problem, we had to bother the general practitioner, who is already “overbooked.” But now I feel extremely safe, knowing that there are [geriatricians] above me, people whom I can ask for advice. I find this really incredible. N, early majority | ||
Strong negative opinion (late majority, laggards). | Mild negative opinion (late majority, laggards) | |
Eg. For me, [the CTM] has nothing to offer. We did just fine without it. PCP, laggard | Eg. Who works 7 days a week? It’s the nurses, not the case managers. So I’m against imposing this person [case manager]. N, laggard |