Implementing a knowledge application program for anxiety and depression in community-based primary mental health care: a multiple case study research protocol.

Pasquale Roberge,Catherine Hudon,Jean-Frédéric Lévesque,Janie Houle,Louise Fournier,Hélène Brouillet,Martin D Provencher

doi:10.1186/1748-5908-8-26

Abstract

BackgroundAnxiety and depressive disorders are increasingly recognized as a health care policy priority. Reducing the treatment gap for common mental disorders requires strengthening the quality of primary mental health care. We developed a knowledge application program designed to improve the organization and delivery of care for anxiety and depression in community-based primary mental health care teams in Quebec, Canada. The principal objectives of the study are: to implement and evaluate this evidence-based knowledge application program; to examine the contextual factors associated with the selection of local quality improvement strategies; to explore barriers and facilitators associated with the implementation of local quality improvement plans; and to study the implementation of local quality monitoring strategies.MethodsThe research design is a mixed-methods prospective multiple case study. The main analysis unit (cases) is composed of the six multidisciplinary community-based primary mental health care teams, and each of the cases has identified at least one primary care medical clinic interested in collaborating with the implementation project. The training modules of the program are based on the Chronic Care Model, and the implementation strategies were developed according to the Promoting Action on Research Implementation in Health Services conceptual framework.DiscussionThe implementation of an evidence-based knowledge application program for anxiety and depression in primary care aims to improve the organization and delivery of mental health services. The uptake of evidence to improve the quality of care for common mental disorders in primary care is a complex process that requires careful consideration of the context in which innovations are introduced. The project will provide a close examination of the interplay between evidence, context and facilitation, and contribute to the understanding of factors associated with the process of implementation of interventions in routine care. The implementation of the knowledge application program with a population health perspective is consistent with the priorities set forth in the current mental health care reform in Quebec. Strengthening primary mental health care will lead to a more efficient health care system.

Highlights

Anxiety and depressive disorders are increasingly recognized as a health care policy priority
We developed the knowledge application program based on the determinants of a successful implementation of change in clinical practice outlined in the PARiHS framework [56,57]
The implementation of an evidence-based knowledge application program for anxiety and depression in primary care aims to improve the organisation and delivery of mental health services from a population perspective. This project will provide in-depth understanding regarding the contextual factors that are associated with the selection of strategies for improvement, the barriers and facilitators throughout the implementation process, and the development of a quality monitoring routine at the local level

Summary

Introduction

Anxiety and depressive disorders are increasingly recognized as a health care policy priority as they are the most common mental disorders among the general population and in primary care [1,2,3,4,5]. Lifetime prevalence is approximately 6.7% for major depression [4] and 16.6% for anxiety disorders [3] These disorders are associated with significant psychological distress, and functional and social impairment [5,6]. People living with these disorders present a high risk of comorbidity, as anxiety and depressive disorders are frequently occurring with other mental disorders as well as chronic physical illness [7,8,9,10]. While the integration of mental health into primary care is paramount to improving access to mental health care, the current reforms require support to strengthen the quality of primary mental health services across a wide variety of contexts [17]

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Conclusion