Shared Care and Usual Health Care for Mental and Comorbid Health Problems. A Cluster Randomized Trial
Conditions: Mental Disorders
Sponsor: University Hospital, Akershus

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Project description Shared care 12feb2014 
 
Is shared primary and mental health care better than current practice for people with 
mental and comorbid illnesses? Cluster randomized trial 
1.Relevance relative to the call for proposals 
Research on challenges in collaboration in health care for mental health:  The model of shared care 
brings together the various services needed for comprehensive and concurrent collaboration for a 
large proportion of general practitioners (GP) patients with mental health problems, as well as 
comorbid illnesses. There is a great variation in such collaboration with unknown effect, and a lack 
of knowledge from rigorous research on characteristics of effective collaboration. 
Research on projects contributing to innovation in the health services: The project supports and will 
assess the effect of adapting an innovative Canadian model for close collaboration in the context of 
Norwegian health services. This may help putting the Collaboration reform into practice in Norway 
and provide examples that can be adopted by other specialties interested in working more closely 
with primary care. 
Interaction with the health services: The project will use register data extracted in collaboration with 
the local health services involved, together with data from service users and health workers. The 
data will be used to analyse how services function and collaborate, and individual results will be 
given to each service, which they may use in improving their practice and local collaboration. 
Research on design, composition and organisation of preventive health services: By making novel 
mental health interventions easier accessible for a large group of GP patients, the model of shared 
care may provide preventive or early intervention for many patients where emerging mental 
problems has not yet been recognised or manifest through symptoms. Easier access may also 
shorten waiting time, and close collaboration may increase competence in early detection by GPs. 
2.Aspects relating to the research project 
Objectives 
To demonstrate the feasibility and impact of shared care on patient experiences and outcome, 
waiting times and the capacity to better handle the mental health problems at an early stage within 
primary care. Shared care means a Norwegian adjusted model of the Family Health Team model 
developed in Hamilton, Canada, where GPs, clinicians and other professionals from primary care 
and specialized mental health care working together as a team co-located in primary care. The 
adjusted model of shared care will be tested against current practice in a cluster randomized trial. 
Work packages (WPs) 
WP1 will investigate current practice and areas for improvement of services and collaboration, 
based on data extracted from the electronic registers in the collaborating services and on survey data 
from patients and health care workers. 
WP2 will be done by the collaborating services supported by the research group. The Family Health 
Team model of shared care will be adjusted to the Norwegian context, based on results of WP1 and 
a study visit to Canada. Then the adjusted model will be implemented, and the implementation 
process and facilitators and barriers for implementation will be investigated. 
WP3 will compare implemented shared care to current practice regarding access to services, 
distribution of patients, patient experiences and outcome, and distribution of tasks and competences. 
We will use a difference-in-difference model with randomised clustering of GPs regarding shared 
care or current practice. 
The research group has received financial support from the Regional Health Authority in South- 
Eastern Norway to initiate this research on shared care, and this money will cover WP2 and parts of 
WP1. (See attached pdf-file with budget). This application is for a PhD research fellow for WP1 and 
a postdoc research fellow for WP3, and some support for data collection in WP3. 

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Project description Shared care 12feb2014 
 
 
2.1.Background and status of knowledge 
Definition and potential advantages of shared care 
Kates et al (2011a) define collaborative mental health care as “care that is delivered by providers from 
different specialties, disciplines, or sectors working together to offer complementary services and 
mutual support. As in any effective partnership, common goals, clear and equitable decision making, 
and open and regular communication are keys.” 
Effective collaboration is essential both within and between primary care, mental health care and 
substance abuse care. Lack of coordination between health care levels has, however, been pointed out 
repeatedly by consumer organizations and health authorities. In Norway, primary care and GPs are 
funded through municipalities/boroughs and specialised mental health care through state owned health 
authorities. This split and the activity based financing in both primary care (GPs) and specialist care 
adds to the challenges of collaboration. This also creates selection problems because both hospitals and 
GPs will have (financial) incentives to attract profitable patients (cream- skimming) and to skimp 
and/or dump unprofitable patients by referring them to the other health care level. 
Current knowledge regarding shared care 
Research-based knowledge about the effect of shared care is inconclusive. A Cochrane review by 
Smith et al. (2009) concluded that there was insufficient evidence to demonstrate significant benefits 
from shared care apart from improved prescribing. In another Cochrane review (Harkness and Bower 
2009) the effects of on-site delivered psychological therapy to patients in primary care resulted in 
reductions in primary care provider consultations, prescribing costs, and rates of mental health 
referrals. However, the changes were modest and inconsistent resulting in unclear clinical or economic 
significance of the results. A review conducted by Butler et al. (2011) concluded that integrated care 
appeared to improve depression management in primary care patients, but not necessarily symptom 
improvement. 
Research on collaboration has mainly been in the area of depression and anxiety, and then primarily on 
simpler models of collaboration between two parties, usually a doctor and nurse (Hviding et al. 
2008, Craven et al 2006) or between a therapist and a GP (von Orden et al. 2009). Some of the most 
important factors in the collaboration between health care seems to be the establishment of 
collaborative relationships, shared goals, a structured organization of collaboration, and co-location or 
close physical proximity of collaborators (Seaburn et al. 1996). 
The general practitioner (GP) is a key person in primary care (Lampe et al 2012), including for mental 
health. Most referrals to specialized health services are done by the GP, and the GP is also important in 
referring to and collaborating with primary mental health care in the municipality. There is great 
variation in how GPs work with mental illness, partly depending on their interest, but also depending 
on the support the GP may receive from other professionals and services (Fleury et al 2012a, 2012b). 
In Norway the field of primary mental health care with teams of mental health workers has been 
extensively developed during the last 10-15 years, but there seems to be a large variation in the degree 
of collaboration between GPs and these primary mental health care teams. 
According to user organizations, the lack of collaboration is an important area for improvement, as 
both patients and their families frequently experience fragmentation of health services. There have 
been various forms of collaboration in Norway between Community Mental Health Centres (CMHCs), 
GPs and primary health and social care. But with a lack of rigorous research on such models, we have 
little knowledge on how they function and whether they contribute to better patient satisfaction and 
better outcome. 
Family Health Teams – a model that will be adjusted to the Norwegian context 
The Family Health Team shared care model as developed in Hamilton, Canada, offer a promising 
model of shared care (Kates 2011a, 2011b).This is built around GP practices. Each team include one or 
more GPs in addition to nurses, mental health counsellors, a visiting consultant psychiatrist, and some 
other part-time staff (pharmacist, nutritionist, physiotherapist, occupational therapist). Team members 
are co-located and provide coordinated health care for both physical and mental 

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Project description Shared care 12feb2014 
 
 
illness. This enhances primary care staff’s ability to treat more patients, in turn resulting in fewer 
referrals to secondary and tertiary specialised services. 
The goal is to provide comprehensive health care close to where the patient lives, with minimal 
fragmentation and with the ability to integrate the treatment of co-morbid somatic and mental diseases. 
This model has significantly increased access to care for individuals with mental health and addiction 
problems and reduced waiting times. It has reduced the use of in-patient and out- patient mental health 
services, improved communication and co-ordination and is greatly appreciated by patients who also 
find it less stigmatizing. It has also demonstrated significant improvement in up to 70% of patients, and 
GPs feel more confident and skilled in treating mental health problems (Kates 2011a, 2011b). 
The model is consistent with the aims of the Norwegian Collaboration Reform by offering more 
assessments and treatment within primary care by close collaboration, including with resources from 
mental health services and the municipality/borough. It is anticipated that the model is well 
suited to serve patients and families from ethnic minority who in general show higher prevalence of 
mental illness yet lower use of specialist services (Ayazi & Bøgwald 2008). 
2.2.Approaches, hypotheses and choices of methods 
The setting for the project 
Alna, Grorud and Stovner are three boroughs in the north-eastern part of Oslo. They are served by DPS 
Groruddalen (Community Mental Health Centre) and other departments in Division of Mental Health 
Services of Akershus University Hospital (Ahus). As shown in the attached letters, the boroughs and 
the CMHC are committed to test an adapted model of shared care. The boroughs are among those in 
Norway with the highest proportion of people from ethnic minorities, providing an opportunity to focus 
attention on how these populations’ needs can be met. 
Populations and number of GP group practices in the boroughs are shown in the table below. 
 
Borough 
Population 
Immigrants* 
GP groups 
Number of GPs 
Alna 
47 000 
22 000 (47%) 
11 
37 
Grorud 
26 000 
11 000 (42%) 
5 
20 
Stovner 
31 000 
14 000 (45%) 
4 
22 
Total 
104 000 
47 000 (45%) 
20 
79 
*) Including first generation immigrants 
During 2013 there have been discussions between the CMHC and the boroughs on how to improve the 
collaboration between the primary care and the specialized mental health care, and the services are 
finding that the model of shared care may be adjusted to the local context. Some GPs have also been 
involved in these discussions, and the GPs in the research group will approach the GP groups in the 
boroughs during this winter with specific invitation to six GP groups (two in each borough) with 
altogether approximately 24 GPS to participate in the project. 
Cohort definitions and methods common for WP1 and WP 3 
In WP1 and WP3 we will collect data from two similar cohorts of patients and in similar ways. This is 
outlined here and referred to in the descriptions of WP1 and WP3 below. 
We will recruit approximately 24 GPs working in two different GP group practices in each of the three 
boroughs listed above. These GPs must be willing to take part in both WP1 and WP3, and they must be 
willing to be randomized (as groups) to be involved in shared care or continue with current practice. 
Register Cohort 
Register Cohort: All patients 16-65 years old and seen by the 24 GPs during 12 months. The reason for 
choosing 12 months is to have a long enough period to get enough data on referrals between services. 
Variables: Age, gender, marital status, borough, GP, referrals, ICPC-2 codes/ICD-10 diagnoses, GAC 
scores, GP consultations, outpatient consultations and inpatient stays in specialized mental 

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Project description Shared care 12feb2014 
 
 
health and substance abuse services, type of ward/team, use of coercion, codes on treatment 
procedures, social care, employment, sick leave and prescriptions of medication. 
Data collection: Data are extracted from the GP patient records, accident and emergency clinics in 
Oslo, Akershus University Hospital (specialized mental health and substance abuse services for adults 
and youth), NAV (the social care, work/sick leave and social security agency). Data 
extraction from GP records and the accident and emergency clinics are done by Svein Gjelstad, who is 
a member of the research group and has a company (Mediata) specializing in such data extraction with 
extensive experience from other studies. Data from electronic hospital patient records will be extracted 
by ICT engineers in the Research Support Centre of the hospital, following procedures used in several 
previous studies. Data from the other registers are ordered from these according to their procedures. All 
data files will include the personal identity number used in Norway, and they will be linked by NAV. 
The research group will receive an anonymous data file. 
Clinical Cohort 
Clinical Cohort: Patients 16-65 years old seen by the 24 GPs during 4 weeks within the 12 months of 
the Register Cohort, and giving written consent to participate in the outcome study. This includes 
filling in a one page questionnaire at the index consultation, receiving a similar questionnaire 3 and 
9 months later, and giving consent to link the data on the questionnaires to the data from the Register 
Cohort described above. The questionnaire after 3 months will measure short term outcome and 
satisfaction, and the questionnaire after 9 months will measure longer term outcome and satisfaction. 
From experiences in earlier studies with similar procedures in GP practices, we expect that 70-80 % 
will give consent (probably somewhat lower for immigrants). 
Variables: Age, gender, borough, GP, satisfaction with health services (CSQ-8), mental health 
problems (CORE-10), substance abuse (CAGE-4), waiting time, experience of collaboration. The 
primary outcome measure in the cluster randomized trial will be the Client Satisfaction Questionnaire 
(CSQ-8), which has been used extensively in research (Larson 1979). The secondary outcome 
measures will be CORE-OM 10 (10 items, Barkham 2013), which is a short form of the now well 
established questionnaire CORE-OM on mental health problems. It has excellent psychometric 
properties and is available in Norwegian. 
Data collection: At each GP group a staff member is paid part time by the project during the four 
weeks to administer the questionnaire to the patients seen by the GPs. The patient will receive the 
questionnaire and information on the study when they arrive and deliver it to the staff member when 
they leave. The staff member will receive the completed questionnaire and written consent from 
patients that agree to participate. The questionnaire will be available in Norwegian and English, and the 
staff member will be available to help the patient if requested. The PhD candidate or other members 
from the research group will visit these staff members weekly during the data collection period to 
support them and to collect the completed forms. The questionnaires at 3 and 9 months follow-up will 
be sent as paper forms by mail. (We may consider electronic data collection on smart phones in 
collaboration with experts.) 
Health Worker Cohort 
Health Worker Cohort: The approximately 24 GPs and staff in the six GP groups recruited for the 
study, the clinicians and other staff at the outpatient clinics and mobile teams in the CMHC (and BUP 
and ARA?), and health and social workers in the primary mental health and substance abuse care and 
social care (NAV), any primary care for adolescents. 
Variables: Pattern of collaboration last 6 months (with whom, how, how often), assessment of the 
quality of the services and the collaboration, suggested improvements in collaboration. The questions 
on collaboration will be based on the Hamilton Clinician Activity Instrument developed by the research 
group in Canada, but tailored to the Norwegian setting. 
Data collection: Data from the GPs and other health workers will be collected using the Snap Survey 
software for electronic data collection on internet. A project coordinator in the R&D Department in the 
Division of Mental Health Services, Akershus University Hospital, will design 

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Project description Shared care 12feb2014 
 
 
the electronic form, collect email addresses from the services, send out emails with a link to the 
electronic web based questionnaire, and make the data available as data files ready for analysis. 
Estimated sizes of cohorts 
Estimated size of the Register Cohort: Based on knowledge from the patient registers involved, we 
have estimated that the sample size of the Register Cohort in WP1 will be approximately 20100 
patients. This builds on estimates that the 24 GPs see 70 % of their 1200 list patients during a year. 
Estimated size of the Clinical Cohort: Building on the estimated size of the Register Cohort (above), 
we estimate that the 24 GPs will see altogether 1800 patients during 4 weeks, as 4 weeks are 1/11 of 
the 44 weeks a year that the GP is required to run their practice. If 75 % give consent to take part in the 
study on patient satisfaction and outcome, this will be 1350 patients. 
Estimated size of the Health Worker Cohort: Approximately 24 GPs, 40 clinicians at outpatient clinics 
and mobile teams and 6o mental health and social workers in the boroughs is expected to fill in the 
questionnaire on experiences of current practice, needs for improvements and shared care. 
Handling of completed questionnaires and data files 
Completed questionnaires from the Clinical Cohort will be kept locked in a safe place at each GP 
group and collected weekly by the PhD candidate or other members of the research group. The data 
will be registered by project coordinators in the R&D Department in the Division of Mental Health 
Services, Akershus University Hospital, in a data base on the approved and secure research server 
dedicated to research data in Akershus University Hospital. The anonymous data files from the 
Register Cohort will also be saved on the same dedicated research server at the hospital. 
Approval of the project 
Application is sent in February 2014 to the Regional Committee on Ethics in Health Research (REK) 
for approval of the project, including extracting data from the electronic registers and for having the 
data linked by NAV. The data file that will be made available for the research group will be 
anonymous. 
WP1: Study of current practice and needs for improved collaboration 
The aim for WP1 is to study current practice and study needs for improved collaboration. These results 
will also be used as a baseline in the before-and-after design to control for differences among sites in 
the comparative study in WP3. 
Research questions for WP1 
1. What are the characteristics of patients seen in the current practice (ICPC-2 codes, mental health 
problems, drug problems, functioning, service utilization, quality of life)? 
2. What are the patterns of collaborative contacts and activities? 
3. How satisfied are patients with the services they receive and the collaboration between them? 
4. What do the GPs, primary care and mental health services want and need regarding collaboration 
and competence? 
Design of WP1 
See above for descriptions common to WP1 and WP3, as well as definitions of the cohorts. 
Cohorts and periods for data collections in WP1 
Register Cohort in WP1 will be all patients seen by the 24 GPs from July 1st 2013 to June 30th 2014. 
The data will be extracted from the registers for the same period of time. The data extraction will be 
done in September 2014. Clinical Cohort in WP1 will be patients seen by the 24 GPs during four 
weeks in May/June 2014. Health Worker Cohort in WP1 will be the 24 GPs and the clinicians and 
health workers in the other agencies in May 2014. 
WP2: Adapting and implementing the Norwegian model for shared care 
WP2 will be done by the collaborating services supported by the research group. The Family Health 
Team model of shared care will be adapted to the Norwegian context, based on results of WP1 and a 
visit to Canada to learn more about the model. In this process we follow advice given by the Medical 

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Project description Shared care 12feb2014 
 
Research Council in UK regarding the needs to adapt models to the local context as a part of research 
(Craig et al 2008). Then the Norwegian model will be implemented, and the implementation process 
and facilitators and barriers for implementation will be investigated. 
A suggested outline of the framework for a model for shared care 
Following discussions in the research group and with some of the services interested in trying a model 
of shared care, a suggested framework for a model may be: Shared care is implemented by developing 
a multidisciplinary team of health and social workers from the primary mental health care, the 
outpatient clinic of the CMHC and social care (NAV). There should be rooms available for the team 
within or close to the GP groups taking part in shared care. 
There may be one team serving all the three GP groups, or there may be separate teams or sub- teams. 
If there are separate teams, some of the resources may be shared by the teams. 
The teams may include persons full time or part time, and it may have access on a regular or ad hoc 
basis to persons working in other services not represented in the team. 
The process of defining and deciding on design of the adjusted shared care model 
The Norwegian shared care model will be specified late in the autumn of 2014 based on the following 
sources of information: 
 Analyses of the patterns of distribution and referrals between the GPs, primary mental health care, 
social care and specialised mental health services. 
 Analyses of what GP patients, GPs and other health and social workers has answered in 
questionnaires on current practice and on the needs for improvement in collaboration. 
 Analyses of questionnaires and qualitative interviews/focus groups with patients, GPs and health 
workers on experiences with current practice, and their suggestions for improvement of practices 
and collaboration. 
 Advisory groups of patients with experiences as services users may give important advice on the 
needs and on drafts of a Norwegian model of shared care. 
 Knowledge on the Family Health Team model from available literature, like papers by Kates 
 (2011a, 2011b) and tool kits from the CCMHI. 
 Information, experiences and ideas of service user representatives, GPs, health workers and 
researchers from the visit with the Family Health Teams in Hamilton, Ontario, Canada. 
The adjustments and specifications will be done by the services that will take part in the shared care 
collaboration, as they are the ones who have to agree on what to do and what each part will contribute 
with. The research group will give input by sharing the results from WP1. The specification of the 
adjusted model for shared care need to include composition, leadership and organization of the team, as 
well as a description on the services to be given. 
A suggested outline of the process of implementation of shared care 
The implementation of shared care is expected to start as early as possible in 2015, while the 
momentum from the process during the autumn of 2014 is still present. 
From research on implementation of new models of treatment, we know that implementation of a 
model usually takes 6-12 months. Much may be accomplished in 6 months if the implementation is 
well organized with regular supervision and feedback. The research team may contribute to design of 
the implementation process and provide feedback from WP1 data. 
Supervision will be available as needed from Hamilton and/or by professionals in Norway who is 
considered to have competence and skills needed for such a process. 
WP3: Comparing shared care with current practice 
Research questions in WP3 
1. What are the experiences of the users with shared care compared to current practice? 
2. What is the impact on services utilization and referral patterns? 
3. Is there an increase in availability (more users treated for mental health problems?) 
4. Successful earlier intervention in the course of illness (prevention, shorter waiting time? ) 

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Project description Shared care 12feb2014 
 
5. Is co-morbidity (somatic, substance abuse) better identified and treated with the Norwegian shared 
care model than in current practice? 
6. Are there competences in service providers that promote closer collaboration? 
7. Are GPs and other services more satisfied with the Norwegian shared care model than with their 
earlier practice? 
8. What is the patient course and outcome with the Norwegian shared care model compared to current 
practice? 
9. What is the impact on the patient experience? 
10. Also increase in collaboration between GPs and primary health care? 
Design of WP3 
See above for descriptions common to WP1 and WP3, as well as definitions of the cohorts. 
Cohorts in WP3 
The Register Cohort in WP3 will be all patients seen by the 24 recruited GPs (see above) from January 
1st 2016 to December 31st 2016. The data will be extracted from the registers for the same period of 
time. This is the year after the implementation during 2015 of the adjusted model of 
shared care.  The data extraction will be done in February 2017. The Clinical Cohort in WP3 will be 
patients seen by the 24 GPs during four weeks in January 2016. The Health Worker Cohort in WP3 
will be the 24 GPs and the clinicians and health workers in the other agencies in January 2016. 
Cluster randomized controlled trial 
WP3 is a cluster randomised study. Two GP groups in each of the three boroughs will be randomised 
to take part in the implementation of shared care or continue with their current practice. The 
randomisation will be done in the summer of 2014, so that some GPs randomised to shared care may 
take part in the planned study visit to Canada in September 2014 to see the Family Health Team model 
in operation. The GPs randomised to current practice may take part in implementing shared care after 
the research study if the model proves to be successful. 
Power calculations for the Clinical Cohort in WP3 
Power calculation with 90 % power and CSQ as primary outcome measure shows that to detect a 
difference of half a SD (3.8) in patient satisfaction between shared care and current practice, we need 
85 patients in each arm in a controlled trial with randomisation of individuals. For a cluster randomised 
trial with ICC=0.03 and 12 GPs in each arm, we need 101 patients in each arm (9 or more per GP). 
Calculation is done as defined for cluster randomised trials in health services research (Eldridge & 
Kerry 2012), with elaboration of the CONSORT statement in relation to cluster randomised trials 
(Schultz et al 2010, Moher et al 2010). 
Statistical analyses 
Standard statistical analyses will be used to describe various parts of the material, test significant 
differences, and analyse explanatory models. Growth curve or multilevel analyses will be done of 
individual progress, with data on the use and services (including collaboration) as explanatory 
variables. Statisticians at the Research Centre, Akershus University Hospital will give advice and assist 
with more complex analyses, such as growth curve analysis. 
The project plan, project management, organization and cooperation 
Principal Investigator is Professor Torleif Ruud, head of the The R&D Department, Division Mental 
Health Services, Akershus University Hospital (Ahus). The department has 7 senior researchers (3 
psychiatrists, 1 child/adolescent psychiatrist, 3 psychologists). One is professor and two are associate 
professors at the University of Oslo. There are and 12 PhD research fellows and a research support 
staff. Implementation and quality of mental health services is one priority area, and experiences of 
users and carers another. The department is co-located with the Health Services Research Centre, with 
statisticians and ICT experts on patient data extraction. 
Project group (see also CVs) 
Professor Torleif Ruud, Principal Investigator. Head of R&D Department Mental Health Services, 
Akershus University Hospital (Ahus), specialist in psychiatry and professor at the Clinic for Health 

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Project description Shared care 12feb2014 
 
 
Services Research and Psychiatry, Institute of Clinical Medicine, University of Oslo. He has been 
medical director and psychiatrist at a pioneering CMHC with close collaboration with primary care, 
and he has extensive experiences in mental health services research. 
Associate Professor Ole Rikard Haavet, Department of General Practice, Institute of Health and 
Society, University of Oslo, is conducting research in general practice and primary care, including on 
mental health and evidence based practice. He works as a GP, and he chaired development of national 
guidelines for GPs work with adolescents with mental problems. He will take part in recruiting GP 
groups to the study, be main supervisor for the PhD research fellow in WP1. 
Consultant psychiatrist and researcher Ajmal Hussain at the outpatient clinic at DPS Groruddalen 
(CMHC) will be a key researcher in the project. He has done a PhD on effects of trauma, and is now 
working half time as clinician and half time as researcher. He will be the consultant in the shared care 
team in the project, and is a member of the research group. 
Senior Researcher Jorun Rugkåsa, Health Services Research Unit, Akershus University Hospital, also 
has a part time position in the Social Psychiatry Group, Oxford University, UK. She has extensive 
experience of health services research from Ireland, Northern Ireland, England and Norway. She is a 
member of the research group and will supervise qualitative interviews. 
Professor Nick Kates, McMaster University, Hamilton, Ontario, Canada, has led the development of 
the Family Health Team Shared Care Model in Hamilton for 20 years, and led the national project 
Canadian Collaborative Mental Health Initiative (CCMHI) on models and knowledge of the interaction 
between primary care and mental health care. He has taken part in designing the study. 
Professor Mette Brekke, Department of General Practice, Institute of Health and Society, University of 
Oslo, is doing research on general practice and primary care. She is a member of the research group 
and will be co-supervisor for the PhD research fellow in WP1. 
Economist and Senior Researcher Inger Cathrine Kann, Health Services Research, Akershus 
University Hospital, has PhD and extensive research experience on register studies on GP practices, 
primary care and social services. She will design and analyse the studies on register data. 
GP and researcher Svein Gjelstad has done his PhD on a study on GP practices, and has developed and 
used in research a software package which extracts data from the electronic patient record systems used 
by GPs. He will manage extraction of data from the GPs included in the study. 
Assistant Professor Lurås, health economist, Research Director of the Akershus University Hospital 
Research Centre, including the Centre for Health Services Research (HØKH). She is an advisor 
throughout the process. 
Service user expert Dagfinn Bjørgen, The National Centre for User Experiences in Mental Health 
(Erfaringskompetanse.no) is in charge of their engagement in research, and will contribute to have user 
perspectives well represented in shared care and in measuring user experiences. He is now also the 
national leader of Mental Health Norway, the largest user organization in mental health. He is involved 
in design, adaption and implementation of the model of shared care, and data analyses and 
interpretation. He may also involve others from their organisations. 
Research Leader Anne Landheim, The National Competence Services for Concurrent Substance Abuse 
and Mental Illness, Innlandet Hospital, has extensive research experience on comorbidity of mental 
illness and substance use, and was involved in developing national clinical guidelines. She is an 
advisor throughout the process. 
Specification of what the two research fellows will do 
 
PhD candidate at the Department of General Practice, University of Oslo 
Period: 1st September 2014 to 30th August 2017. The PhD candidate, who will be supervised by 
Associate Professor Haavet and Professor Brekke, will be involved in the WP1 study on current 
practice. The papers in the thesis will be on patients seen by the various services, the collaboration 
between the services and user experiences of the current practice. The PhD candidate will also take part 
in adapting the shared care model for the Norwegian context and preparing the implementation. 

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Project description Shared care 12feb2014 
 
 
Postdoc at the R&D Department, Mental Health Services, Akershus University Hospital  
Period: 1st July 2015 to 30th June 2018: The postdoc research fellow will be involved in the WP3 study 
on comparing shared care with current practice. He/she will publish papers on patient outcomes, 
patient satisfaction and changes in services related to the model of shared care. 
Dissemination and use of the results (more in the application form) 
The results will be given as feedback to the various services, including a profile of their practice and 
the average profile for similar services in the project. Three scientific papers from each of the research 
fellows will be published, as outlined in the application form. The project will give input 
the health authorities on the possibility to use shared care on a larger scale to improve collaboration 
among primary and mental health care. 
The results of WP1 will be used in WP2 to define and plan the shared care teams and their way of 
working. This model will then also be discussed with the GPs and other services as a part of WP2. 
Plan of progress. Plan of progress is detailed in the application form. 
2.4.Budget. The budget with comments is included in the application form. 
 
3.Key perspectives and compliance with strategic documents 
3.1.Complience with strategic documents 
The South-Eastern Regional Health Authority and Ahus have collaboration with primary care as a 
central goal in their strategic documents. The project is addressing several of the key challenges in 
specifying and implementing the national Collaboration Reform agreed in the Parliament. 
3.2.Relevance and benefit to society 
The model of shared care between primary care and mental health care may help develop better 
services for people with mental illness and co-morbid illnesses. Results and experiences with the model 
may also be generalizable to other aspects of the Collaboration Reform in Norway. 
3.3.Environmental impact 
The project is not expected to influence the physical environment, but can contribute to the 
improvement of the psycho-social environment for people with severe mental illness. 
3.4.Ethical perspectives 
Application of approval of the study is sent in February 2014 to the Regional Committee for Ethics in 
Research (REK), as well as to the Privacy Ombudsman at Akershus University Hospital. The goal of 
this project is to contribute to the improvement of services for people with mental illnesses, which has 
positive ethical aspects. Data collection can be experienced by some users as a burden, and perhaps 
positively by others. 
3.5.Gender issues (Recruitment of women, gender balance, gender perspectives) 
Both women and men will be recruited for participation in the study. Statistical analyses will include 
whether shared care changes how men and women are reached by the services, and whether there are 
differences in how men and women experience current practice and shared care. 
 
4.Dissemination and communication of results 
4.1.Dissemination plan The dissemination plan is written in the application. 
4.2.Communication with users 
The National Centre for User Experiences in Mental Health (Erfaringskompetanse.no) is an important 
collaborating partner designing the study, interpreting results, disseminating user experience and other 
results, and influencing health authorities and services to larger scale implementation of new successful 
models for service delivery. The results will be shared by users and to users in collaboration with these, 
including on their website www.erfaringskompetanse.no. 

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Project description Shared care 12feb2014 
 
 
References 
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