Frontline experiences of developing a feasible integrated model of care for chronic physical conditions and mental disorders in primary care: BRIng your Thoughts and Experiences

Justification: Developing a feasible integrated healthcare model for chronic noncommunicable disease and mental health problems is an established research priority for primary care in Brazil. To meet that aim, several innovative financial and structural strategies have been created by the Brazilian Ministries of Health and Education. As a researcher I have been working closely with Brazilian primary care professionals for two years with the aim to develop a feasible integrated healthcare model. Regional healthcare policymakers and primary care providers have been very cooperative, but I have observed a number of systemic problems that makes the task of proposing a feasible integrated healthcare model questionable or at least extremely challenging.
Content: In Brazilian primary care, some of the main challenges include poor communication between levels of the decentralized and fragmentized healthcare system; limited access to specialist care or in rural areas even no access at all; simultaneous existence of several types of primary care units and overburden of higher levels of care by frequent self-referrals. Working conditions in primary care units can be difficult, with primary healthcare professionals reporting feeling very stressed, overburdened and undervalued, often lacking basic equipment and training in integrated care. What strategies to overcome problems in access, continuity and integration of care have you successfully applied? What have failed to work or what do you think might be feasible in primary care?