Challenges of providing collaborative care for comorbid depression and hypertension in low resource settings in China

The co-occurrence of depression and cardiovascular disease (CVD) has been well established globally andmore recently in China (Ren et al., 2014). Based on a systematic review of 27 Chinese studies, the prevalence of depression amongst CVDpatients was found to be 51% in hospital patients and 40.2% amongst community patients. Other conditions such as cancer have been shown to also have high rates of co-occurrence of depression and anxiety. Yang et al.’s (2013) systematic review of Chinese studies showed a rate of 54.9% for depression amongst cancer patients. The co-occurrence of mental disorders with CVD has also been shown to be costly and burdensome for those afflicted (Haschke et al., 2012). Patient-centered care approaches to the people with comorbid mental and physical health problems are promoted globally (Cohen, 2017). Patient-centered care approaches require collaboration between key professionals and health services to deliver the right care, in the right place, and at the right time. Integrated care systems to improve patient care across primary, secondary, and tertiary care (World Health Organization, 2016) and collaborative care approaches (Unutzer et al., 2020) to improve access to mental health services in primary care have been implemented in many countries. In high health resource countries such as the United Kingdom, integrated care systems bring together health care providers and other service stakeholders to integrate physical, mental, and social health care for local populations (Charles et al., 2018). In Australia, integrated care focuses on the physical andmental health of the population from prevention through to end of life. The approach involves the individual, their families, and carers in partnership with providers across the entire health system (New South Wales [NSW] Government, 2014). Collaborative care specifically focuses on the integration of mental health services within primary care services. Such approaches are more difficult in low resource countries such as China where there is a dominance of hospital-based care (World Bank Group WHO et al., 2016). Achieving service integration is especially important where patients are receiving services from different health professionals for comorbid physical and mental health conditions. But there is some uncertainty concerning the benefits of collaborative care for comorbid depression and CVD (Tully and Baumeister, 2015). In this volume, Li et al. (2019) report the qualitative implementation findings of a collaborative care model (COACH) situated in a low resource, Chinese primary care setting. The study intervention incorporates village doctors, “aging” workers who work with older patients, and psychiatrist consultants tomanage hypertension and depression in older adults. The work by Li and colleagues is of interest because it addresses areas of uncertainty about the best approaches to be taken with what is a demonstrably highly prevalent combination of disorders. Each condition requires critical attention because of their individual burden but there may be benefit in collaborative care to address both contemporaneously. Li et al. (2019) address this key issue in how to best structure treatment for this important patient population. This work is also useful in that it is conducted in the Chinese context. China has unique epidemiology and also a health system that is differently structured to Western countries (Sun et al., 2019). It is therefore appropriate that this investigation has been conducted specifically in the China context in order to understand what is most effective within it. The authors are to be commended for the focus of this work. The current work is the qualitative arm of the COACH randomized controlled trial (RCT) (Chen et al. 2018) being conducted by the researchers and this is the focus of our commentary. The authors conducted focus groups with the collaborative care team to understand the team’s experiences of the COACH intervention. They used normalization process theory (NPT) to categorize and code the participants’ perceptions. NPT has widespread use in understanding implementation from the perspective of stakeholders in order to identify the facilitators of and barriers to the implementation of new health care approaches (Overbeck et al., 2016). The focus group participants valued the variation in the team’s skills and the training provided, were International Psychogeriatrics (2020), 32:12, 1405–1407 © International Psychogeriatric Association 2020