Abstract
BackgroundGeneral practitioners (GPs) in Australia play a central role in the delivery of mental health care. This article describes the PULSAR (Principles Unite Local Services Assisting Recovery) Primary Care protocol, a novel mixed methods evaluation of a training intervention for GPs in recovery-oriented practice. The aim of the intervention is to optimize personal recovery in patients consulting study GPs for mental health issues.MethodsThe intervention mixed methods design involves a stepped-wedge cluster randomized controlled trial testing the outcomes of training in recovery-oriented practice, together with an embedded qualitative study to identify the contextual enablers and challenges to implementing recovery-oriented practice. The project is conducted in Victoria, Australia between 2013 and 2017. Eighteen general practices and community health centers are randomly allocated to one of two steps (nine months apart) to start an intervention comprising GP training in the delivery of recovery-oriented practice. Data collection consists of cross-sectional surveys collected from patients of participating GPs at baseline, and again at the end of Steps 1 and 2. The primary outcome is improvement in personal recovery using responses to the Questionnaire about the Process of Recovery. Secondary outcomes are improvements in patient-rated measures of personal recovery and wellbeing, and of the recovery-oriented practice they have received, using the INSPIRE questionnaire, the Warwick-Edinburgh Mental Well-being Scale, and the Kessler Psychological Distress Scale. Participant data will be analyzed in the group that the cluster was assigned to at each study time point. Another per-protocol dataset will contain all data time-stamped according to the date of intervention received at each cluster site. Qualitative interviews with GPs and patients at three and nine months post-training will investigate experiences and challenges related to implementing recovery-oriented practice in primary care.DiscussionRecovery-oriented practice is gaining increasing prominence in mental health service delivery and the outcomes of such an approach within the primary care sector for the first time will be evaluated in this project. If findings are positive, the intervention has the potential to extend recovery-oriented practice to GPs throughout the community.Trial registrationAustralian and New Zealand Clinical Trial Registry (ACTRN12614001312639). Registered: 8 August 2014.
Highlights
General practitioners (GPs) in Australia play a central role in the delivery of mental health care
Recovery-oriented practice is gaining increasing prominence in mental health service delivery and the outcomes of such an approach within the primary care sector for the first time will be evaluated in this project
Australian primary care and mental health Most Australian medical general practitioners (GPs) work within privately owned general practices where they play an important direct role in the diagnosis and management of mental health problems [1]; around 13% of GP consultations are related to mental health, with depression cited as the most common illness [2, 3]
Summary
Overall design The intervention mixed methods design involves a stepped-wedge cluster randomized controlled trial testing the outcomes of training in recovery-oriented practice, together with an embedded qualitative study to identify the contextual enablers and challenges to implementing recovery-oriented practice within primary care settings. The recruitment sampling method outlined above allows for maximum numbers of patients to be identified who have a choice in deciding whether or not they would like to participate in research This is Statistical analyses The recovery-oriented practice training intervention for primary care will be evaluated at the patient level by examining the surveys of adult patients who consult the participating GPs for mental health issues. Semi-structured interview schedules, informed by literature on the implementation of recovery-oriented practice and consumer and service provider expertise within the PULSAR Qualitative Research Steering Group, were developed to investigate GP and patient views and experiences of recovery-oriented practice within primary care settings These interviews are conducted face-to-face or by telephone at three and nine months following the GP training. The dissemination plan will make the findings widely and readily available along with source training materials
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