REFOCUS-PULSAR Recovery-Oriented Practice Training in Adult Primary Mental Health Care: Exploratory Findings Including From a Pretest-Posttest Evaluation.

Joanne C Enticott,Danielle Mazza,Penelope June Weller,Lisa Mary Brophy,Vrinda Edan,Elisabeth Wilson-Evered,Mike Slade,Graham Nicholas Meadows,Frances Shawyer,Grant Russell

doi:10.3389/fpsyt.2021.625408

Abstract

Objectives: Australian general practitioners (GPs) are pivotal in mental health care. The REFOCUS-PULSAR (Principles Unite Local Services Assisting Recovery) primary care study aimed to improve personal recovery outcomes in adults with mental health problems consulting GPs.Design: Modified from an intended stepped-wedge cluster study, an exploratory (pre- and post-intervention) design employed cross-sectional surveys of patients consulting GPs.Setting: Eighteen primary care sites (clusters) in Victoria, Australia in 2013–2017.Participants: From 30 GPs recruited, 23 participated (76%), with 235 patient surveys returned from adults aged <75 years receiving mental health care.Intervention: A co-delivered face-to-face training intervention for GPs in recovery-oriented practice (ROP), with personal recovery a key focus, used multimedia, mnemonics, and targeted interview schedules to encourage ROP—with availability of support sessions for 1 year.Outcome Measures: Primary: the Questionnaire about the Process of Recovery full-scale score (outcome). Secondary: INSPIRE (experience), Warwick-Edinburgh Mental Well-being Scale (WEMWBS) and Kessler Psychological Distress Scale (K10) (outcomes). Other: General-practice-Users Perceived-need Inventory (experience).Results: Small positive significant effects indicated primary-outcome post-intervention improvements [t-test (233) = −2.23, p = 0.01], also improvement in two secondary outcomes (WEMWBS t(233) = −2.12, p = 0.02 and K10 t(233) = 2.44, p = 0.01). More patients post-intervention reported “no need” for further help from their GP; but in those reporting needs, there was greater unmet need for counseling.Conclusions: ROP implementation, internationally influential in specialist mental health care, here is explored in primary care where it has had less attention. These exploratory findings suggest better patient outcomes followed introducing GPs to ROP in routine practice conditions. Higher unmet need for counseling post-intervention reported by patients might be a sign of limited supply despite ROP facilitating better identification of needs. Challenges in project implementation means that these findings carry risks of bias and flag the importance establishing research infrastructure in primary care.Clinical Trial Registration: www.clinicaltrials.gov/, The Australian and New Zealand Clinical Trial Registry Identifier: ACTRN12614001312639.

Highlights

Mental health-related problems have latterly been reported as the most common reason patients consult general practitioners (GPs) in Australia, increasing from 10.8% of all consultations in 2007–2008 to 12.4% in 2015–2016 [1]
recovery-oriented practice (ROP) implementation, internationally influential in specialist mental health care, here is explored in primary care where it has had less attention. These exploratory findings suggest better patient outcomes followed introducing GPs to ROP in routine practice conditions
Challenges in project implementation means that these findings carry risks of bias and flag the importance establishing research infrastructure in primary care

Summary

Introduction

Mental health-related problems have latterly been reported as the most common reason patients consult general practitioners (GPs) in Australia, increasing from 10.8% of all consultations in 2007–2008 to 12.4% in 2015–2016 [1]. This trend is unsurprising given that mental disorders yearly affect 1-in-5 Australians [2, 3]. Australian government legislation has supported GPs’ central role in the management of mental health problems through the Medicare Better Access to Mental Healthcare initiative (“Better Access”) This initiative, implemented nationally in late 2006, subsidizes access to eligible GPs, psychiatrists, psychologists and other mental health services [4]. Meadows et al [5] examined data from all Australia-wide Better Access services and showed that GP mental health services were far more equitably delivered than services delivered by psychiatrists or clinical psychologists, highlighting the important, frontline role that GPs play in the care of all Australians for mental health conditions [5]

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