***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE We evaluated the implementation of an efficacious collaborative care model for patients with diabetes and depression in a controlled trial in 4 community-based primary care networks ( PCNs ) in Alberta , Canada . Similar to previous r and omized trials , the nurse care manager-led TeamCare intervention demonstrated statistically significant improvements in depressive symptoms compared with usual care . We context ualized TeamCare 's effectiveness by describing implementation fidelity at the organizational and patient levels . METHODS We used the  Reach , Effectiveness , Adoption , Implementation and Maintenance ( RE- AIM ) framework to evaluate TeamCare . Qualitative methods used to collect data regarding the RE- AIM dimensions of Implementation and Effectiveness included interviews with PCN staff and specialists ( n=36 ) , research team reflections ( n=4 ) and systematic documentation . We used content analysis , and Nvivo 10 for data management . RESULTS TeamCare was implemented as intended but with suboptimal fidelity . Deviations from the model included limited degrees of collaborative care practised within the PCNs , including varying physician participation , limited comfort in practising collaborative care and discontinuity of care managers . Despite suboptimal fidelity , respondents identified several implementation facilitators at the organizational level : training , ongoing implementation support , professional and personal qualities of the care manager and pre-existing relationships . Without knowledge of the effectiveness of the intervention in our controlled trial , respondents anticipated improved patient outcomes due to the main intervention components , including active patient follow up , specialist consultation and treat-to-target principles . CONCLUSIONS Despite suboptimal implementation in Alberta 's primary care context , TeamCare result ed in improved outcomes similar to those demonstrated in previous r and omized trials . A stronger culture of collaborative care would likely have yielded greater implementation fidelity and possibly better outcomes INTRODUCTION Evidence -based interventions are often poorly translated into primary care setting s due to inadequate integration into organizational cultures and clinical workflows . Study design s that blend evaluation of effectiveness and implementation may enhance uptake of interventions into primary care setting s. Community-Based Participatory Research ( CBPR ) models are useful for developing partnerships between research teams and primary care clinical partners to test blended study design s. METHODS We conducted a formative evaluation of partnership building between a health services research team and a primary care community in US Veterans Affairs Health System to conduct a r and omized effectiveness trial of an intervention embedded in routine primary care . The formative evaluation used qualitative data drawn from research / clinical partnership meetings . Data were coded and analysed using qualitative framework analysis . RESULTS The CBPR model guided development of a research / clinical partnership based on a facilitation team consisting of ' external facilitators ' ( research team ) , ' internal facilitators ' ( primary care leadership ) and a ' clinical advisory committee ' drawn from the primary care community . Qualitative themes focused on : how the intervention components ( ' evidence ' ) aligned with local clinical cultures , barriers and facilitators to acceptance and adoption of the intervention processes within the context of clinical workflows and identified ' facilitators ' of intervention uptake and sustainability . CONCLUSION A CBPR model can guide the development of research / clinical partnerships . Partnerships can identify barriers and craft modifications to intervention procedures that promote integration and into primary care workflows . Formative research / clinical partnerships are critical for design ing and testing interventions focused on implementation and sustainability of new evidence within routine primary care OBJECTIVE To explore patient and professional views on self-management in the context of telemonitoring in chronic obstructive pulmonary disease ( COPD ) . METHODS Semi-structured interviews with patients with COPD and healthcare professionals participating in a r and omized controlled trial of telemonitoring in Lothian , Scotl and , explored experiences of using telemonitoring , and dynamics in patient-practitioner relationships . Transcribed data were analyzed using the Framework approach . RESULTS 38 patients ( mean age 67.5 years ) and 32 professionals provided 70 interviews . Patients considered that telemonitoring empowered self-management by enhancing their underst and ing of COPD and providing additional justification for their decisions to adjust treatment or seek professional advice . Professionals discussed telemonitoring as promoting compliance with medical advice and encouraged patients to exercise personal responsibility within clinical parameters , but expressed concerns about promoting the sick role and creating dependence on telemonitoring . CONCLUSION Telemonitoring assisted many patients to embrace greater responsibility for their health but the model of service provision remained clinician-centered . A medical model of ' compliant self-management ' may paradoxically have promoted dependence on professionals . PRACTICE IMPLICATION S Patients and professionals shared responsibility for meeting the central objective of prompt management of exacerbations of COPD . Care is needed , however , to minimize the risk in some patients , of telemonitoring increasing dependence on practitioner support Objectives To assess the effect of a point of care ( POC ) device for testing lipids  and HbA1c in addition to testing by community laboratory facilities ( usual practice ) on the completion of cardiovascular disease ( CVD ) risk assessment s in general practice . Methods We conducted a pragmatic , cluster r and omised controlled trial in 20 New Zeal and general practice s stratified by size and rurality and r and omised to POC device plus usual practice or usual practice alone ( controls ) . Patients aged 35–79 years were eligible if they met national guideline criteria for CVD risk assessment . Data on CVD risk assessment s were aggregated using a web-based decision support programme common to each practice . Data entered into the on-line CVD risk assessment form could be saved pending blood test results . The primary outcome was the proportion of completed CVD risk assessment s. Qualitative data on practice processes for CVD risk assessment and feasibility of POC testing were collected at the end of the study by interviews and question naire . The POC testing was supported by a comprehensive quality assurance programme . Results A CVD risk assessment entry was recorded for 7421 patients in 10 POC practice s and 6217 patients in 10 control practice s ; 99.5 % of CVD risk assessment s had complete data in both groups ( adjusted odds ratio 1.02 [ 95%CI 0.61–1.69 ] ) . There were major external influences that affected the trial : including a national performance target for CVD risk assessment and changes to CVD guidelines . All practice s had invested in systems and dedicated staff time to identify and follow up patients to completion . However , the POC device was viewed by most as an additional tool rather than as an opportunity to review practice work flow and leverage the immediate test results for patient education and CVD risk management discussion s. Shortly after commencement , the trial was halted due to a change in the HbA1c test assay performance . The trial restarted after the manufacturing issue was rectified but this affected the end use of the device . Conclusions Performance incentives and external influences were more powerful modifiers of practice behaviours than the POC device in relation to CVD risk assessment completion . The promise of combining risk assessment , communication and management within one consultation was not realised . With shifts in policy focus , the utility of POC devices for patient engagement in CVD preventive care may be demonstrated if fully integrated into the clinical setting . Trial registration Australian New Zeal and Clinical Trials Registry Background Collaborative care ( CC ) is an organisational framework which facilitates the delivery of a mental health intervention to patients by case managers in collaboration with more senior health professionals ( supervisors and GPs ) , and is effective for the management of depression in primary care . However , there remains limited evidence on how to successfully implement this collaborative approach in UK primary care . This study aim ed to explore to what extent CC impacts on professional working relationships , and if CC for depression could be implemented as routine in the primary care setting . Methods This qualitative study explored perspectives of the 6 case managers ( CMs ) , 5 supervisors ( trial research team members ) and 15 general practitioners ( GPs ) from practice s participating in a r and omised controlled trial of CC for depression . Interviews were transcribed verbatim and data was analysed using a two-step approach using an initial thematic analysis , and a secondary analysis using the Normalisation Process Theory concepts of coherence , cognitive participation , collective action and reflexive monitoring with respect to the implementation of CC in primary care . Results Supervisors and CMs demonstrated coherence in their underst and ing of CC , and consequently reported good levels of cognitive participation and collective action regarding delivering and supervising the intervention . GPs interviewed showed limited underst and ing of the CC framework , and reported limited collaboration with CMs : barriers to collaboration were identified . All participants identified the potential or experienced benefits of a collaborative approach to depression management and were able to discuss ways in which collaboration can be facilitated . Conclusion Primary care professionals in this study valued the potential for collaboration , but GPs ’ underst and ing of CC and organisational barriers hindered opportunities for communication . Further work is needed to address these organisational barriers in order to facilitate collaboration around individual patients with depression , including shared IT systems , facilitating opportunities for informal discussion and building in formal collaboration into the CC framework . Trial registration IS RCT N32829227 30/9/2008 Purpose This qualitative study explored the impact and appropriateness of structured pro-active care review s by practice nurses for patients with chronic or recurrent depression and dysthymia within the ProCEED trial . ProCEED ( Pro-active Care and its Evaluation for Enduring Depression ) was a United Kingdom wide r and omised controlled trial , comparing usual general practitioner care with structured ‘ pro-active care ’ which involved 3 monthly review appointments with practice nurses over 2 years for patients with chronic or recurrent depression . Method In-depth interviews were completed with 41 participants : 26 patients receiving pro-active care and 15 practice nurses providing this care . Interview transcripts were analysed thematically using a ‘ framework ’ approach . Results Patients perceived the practice nurses to be appropriate professionals to engage with regarding their depression and most nurses felt confident in a case management role . The development of a therapeutic alliance between the patient and nurse was central to this model and , where it appeared lacking , dissatisfaction was felt by both patients and nurses with a likely negative impact on outcomes . Patient and nurse factors impacting on the therapeutic alliance were identified and nurse typologies explored . Discussion Pro-active care review s utilising practice nurses as case managers were found acceptable by the majority of patients and practice nurses and may be a suitable way to provide care for patients with long-term depression in primary care . Motivated and interested practice nurses could be an appropriate and valuable re source for this patient group . This has implication s for re source decisions by clinicians and commissioners within primary care Background R and omised controlled trials ( RCTs ) of complex interventions in primary health care ( PHC ) are needed to provide evidence -based programmes to achieve the Declaration of Alma Ata goal of making PHC equitable , accessible and universal and to effectively address the rising burden from chronic disease . Process evaluations of these RCTs can provide insight into the causal mechanisms of complex interventions , the context ual factors , and inform as to whether an intervention is ineffective due to implementation failure or failure of the intervention itself . To build on this emerging body of work , we aim to consoli date the methodology and methods from process evaluations of complex interventions in PHC and their findings of facilitators and barriers to intervention implementation in this important area of health service delivery . Methods Systematic review of process evaluations of r and omised controlled trials of complex interventions  which address prevalent major chronic diseases in PHC setting s. Published process evaluations of RCTs will be identified through data base and clinical trial registry search es and contact with authors . Data from each study will be extracted by two review ers using st and ardised forms . Data extracted include descriptive items about ( 1 ) the RCT , ( 2 ) about the process evaluations ( such as methods , theories , risk of bias , analysis of process and outcome data , strengths and limitations ) and ( 3 ) any stated barriers and facilitators to conducting complex interventions . A narrative synthesis of the findings will be presented . Discussion Process evaluation findings are valuable in determining whether a complex intervention should be scaled up or modified for other context s. Publishing this protocol serves to encourage transparency in the reporting of our synthesis of current literature on how process evaluations have been conducted thus far and a deeper underst and ing of potential challenges and solutions to aid in the implementation of effective interventions in PHC beyond the research setting . Systematic review registration PROSPERO The integration of realist evaluation principles within r and omised controlled trials ( ‘ realist RCTs ’ ) enables evaluations of complex interventions to answer questions about what works , for whom and under what circumstances . This allows evaluators to better develop and refine mid-level programme theories . However , this is only one phase in the process of developing and evaluating complex interventions . We describe and exemplify how social scientists can integrate realist principles across all phases of the Medical Research Council framework . Intervention development , modelling , and feasibility and pilot studies need to theorise the context ual conditions necessary for intervention mechanisms to be activated . Where interventions are scaled up and translated into routine practice , realist principles also have much to offer in facilitating knowledge about longer-term sustainability , benefits and harms . Integrating a realist approach across all phases of complex intervention science is vital for considering the feasibility and likely effects of interventions for different localities and population subgroups BACKGROUND A r and omised trial of  nurse-led secondary prevention clinics for coronary heart disease result ed in improved secondary prevention and significantly lowered all-cause mortality at 4-year follow-up . This qualitative trial was conducted to explore the experience of health professionals that had been involved in running the clinics . AIM To identify the barriers and facilitators to establishing secondary prevention clinics for coronary heart disease within primary care . DESIGN OF STUDY Semi-structured audiotaped telephone interviews with  GPs and nurses involved in running clinics .  SETTING A stratified , r and om sample of 19 urban , suburban , and rural general practice s in north-east Scotl and . METHOD Semi-structured telephone interviews with 1 
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Findings were synthesis ed into three key themes : ( 1 ) a fundamental mismatch between what the intervention was design ed to achieve and local needs ; ( 2 ) the required roles and responsibilities of key actors were often not clearly understood ; and ( 3 ) the health system context -factors such as governance , financing structures and workforce-if unanticipated could adversely impact implementation .