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HELSEVEL-Gode og effektive helse-, omsorgs- og velferdstjenester

The regular general practitioner scheme: integrated and equitable pathways of depression care, facilitating work participation

Alternative title: Fastlegeordningens betydning for likeverdige, koordinerte helsetjenester og arbeidsdeltakelse ved depresjon

Awarded: NOK 15.2 mill.

We investigate variation and patient pathways in GP depression care within the framework of the Norwegian Regular General Practice (RGP) Scheme, with an emphasis on patient work participation. We include experiences of patients and professional groups with the health service and its ability to promote participation in working life. Not least, we want to shed light on whether socioeconomic status leads to patients receiving different health services and unequal opportunities for participation in working life. Depression is a core challenge to society. Depressive disorders require person-centered and coordinated health services with particular attention to the risk of exclusion from work life. GPs play a key role in collaborative care, but it is not known to what extent the RGP Scheme promotes equity in the delivery of depression care, and which GP services facilitate work participation. The project follows two lines of inquiry: 1. We examine the extent to which the RGP Scheme promotes delivery of equitable depression care facilitating work participation among patients with depression across gender, age, immigrant background and socioeconomic status. The empirical base for the studies is merged data from several national health and welfare registers. 2. We investigate barriers and facilitators for GP delivery of coordinated depression care, with focus on the needs of patients at high risk of long-term marginalisation. Here, central users including patients and NAV counsellors provide insight into the collaborative processes through focus groups and interviews, together with a questionnaire to a national sample of GPs. The project will generate new knowledge on the collaboration between different actors in the health and welfare service and how the service can be improved to maximize patient benefits. An established user group has an important role in all phases of the project. Results Time trends in GPs' depression treatment indicate that more patients receive talking therapy, while fewer receive medication and sick leave. GP depression care varies: highly educated women are less likely to receive medication than women with low education.

The main objective of this research project is to investigate variations, pathways and experiences in general practitioners’ (GPs) depression care within the framework of the Norwegian Regular General Practice (RGP) Scheme, and its consequences for patients’ work participation. Depression is a core challenge to society. Depressive disorders require person-centred, coordinated and prolonged health care services that are particularly attentive to the risk of exclusion from work life. GPs play a key role in this collaborative care, but it is unknown whether the RGP Scheme ensures equity in the deliv-ery of GPs’ depression care, and which GP services promote work participation among patients with de-pression. The project will apply an interdisciplinary, mixed methods approach, organised into two work packages (WPs). In WP1 we examine the effectiveness of the RGP Scheme in delivering equitable depression care that promote work participation among patients with depression, including comparative analyses of GP services between Norway and the Netherlands. We have received permission to link several national health and welfare registries, and these fully anonymised registries provide the empirical base for WP1. In WP2 we investigate barriers and facilitators for GPs’ delivery of coordinated depression care. Here, crucial users such as patients and NAV counsellors will provide insight into the collaborative processes through focus group discussions, interviews, and a questionnaire to a national sample of GPs. Through advanced epidemiological analyses and qualitative inquiries, we will answer the call to increase knowledge regarding the impact of the RGP Scheme for integrated and equitable pathways of GPs’ depres-sion care, and which pathways that promote work participation. The project will provide new knowledge re-garding service organisation features associated with better health care delivery, to inform future service developments in Norway.

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HELSEVEL-Gode og effektive helse-, omsorgs- og velferdstjenester