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Implementation Science
Published in: Implementation Science 1/2013

Open Access 01-12-2013 | Study protocol

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

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

Published in: Implementation Science | Issue 1/2013

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Abstract

Background

Anxiety 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.

Methods

The 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.

Discussion

The 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.
Literature
1.
Mechanic D: Barriers to help-seeking, detection, and adequate treatment for anxiety and mood disorders: implications for health care policy. J Clin Psychiatry. 2007, 68 (Suppl 2): 20-26.PubMed
2.
Moussavi S, Chatterji S, Verdes E, Tandon A, Patel V, Ustun B: Depression, chronic diseases, and decrements in health: results from the World Health Surveys. Lancet. 2007, 370 (9590): 851-858. 10.1016/S0140-6736(07)61415-9.CrossRefPubMed
3.
Somers JM, Goldner EM, Waraich P, Hsu L: Prevalence and incidence studies of anxiety disorders: a systematic review of the literature. Can J Psychiatry. 2006, 51 (2): 100-113.PubMed
4.
Waraich P, Goldner EM, Somers JM, Hsu L: Prevalence and incidence studies of mood disorders: a systematic review of the literature. Can J Psychiatry. 2004, 49 (2): 124-138.PubMed
5.
Kroenke K, Spitzer RL, Williams JB, Monahan PO, Lowe B: Anxiety disorders in primary care: prevalence, impairment, comorbidity, and detection. Ann Intern Med. 2007, 146 (5): 317-325.CrossRefPubMed
6.
7.
Katon WJ:Living Well with Chronic Illness: A Call for Public Health Action. Improving recognition and quality of depression care in patients with common chronic medical illnesses. 2012, Washington, DC: The National Academies Press,
8.
Roy-Byrne PP, Davidson KW, Kessler RC, Asmundson GJ, Goodwin RD, Kubzansky L, Lydiard RB, Massie MJ, Katon W, Laden SK, Stein MB: Anxiety disorders and comorbid medical illness. Gen Hosp Psychiatry. 2008, 30 (3): 208-225. 10.1016/j.genhosppsych.2007.12.006.CrossRefPubMed
9.
Lamers F, van Oppen P, Comijs HC, Smit JH, Spinhoven P, van Balkom AJ, Nolen WA, Zitman FG, Beekman AT, Penninx BW: Comorbidity patterns of anxiety and depressive disorders in a large cohort study: the Netherlands Study of Depression and Anxiety (NESDA). J Clin Psychiatry. 2011, 72 (3): 341-348. 10.4088/JCP.10m06176blu.CrossRefPubMed
10.
Conway KP, Compton W, Stinson FS, Grant BF: Lifetime comorbidity of DSM-IV mood and anxiety disorders and specific drug use disorders: results from the National Epidemiologic Survey on Alcohol and Related Conditions. J Clin Psychiatry. 2006, 67 (2): 247-257. 10.4088/JCP.v67n0211.CrossRefPubMed
11.
Vasiliadis HM, Dionne PA, Preville M, Gentil L, Berbiche D, Latimer E: The excess healthcare costs associated with depression and anxiety in elderly living in the community. Am J Geriatr Psychiatry. 2012, 10.1097/JGP.0b013e318248ae9e.
12.
Roberge P, Marchand A, Reinharz D, Cloutier K, Mainguy N, Miller JM, Bégin J, Turcotte J: Healthcare utilization following cognitive-behavioral treatment for panic disorder with agoraphobia. Cogn Behav Ther. 2005, 34 (2): 79-88. 10.1080/16506070510008443.CrossRefPubMed
13.
Lim K, Jacobs P, Ohinmaa A, Schopflocher D, Dewa CS: A new population-based measure of the economic burden of mental illness in Canada. Chronic Dis Can. 2008, 28 (3): 92-98.PubMed
14.
Jacob V, Chattopadhyay SK, Sipe TA, Thota AB, Byard GJ, Chapman DP, Community Preventive Services Task Force: Economics of collaborative care for management of depressive disorders: a community guide systematic review. Am J Prev Med. 2012, 42 (5): 539-549. 10.1016/j.amepre.2012.01.011.CrossRefPubMed
15.
Horton R: Launching a new movement for mental health. Lancet. 2007, 370 (9590): 806-10.1016/S0140-6736(07)61243-4.CrossRefPubMed
16.
Kirby M, Keon W: Out of the shadows at last. Transforming mental health, mental illness and addiction services in Canada. 2006, Senate of Canada: Standing Senate Committee on Social Affairs, Science and Technology
17.
18.
Gask L, Lester H, Kendrick T, Peveler R: Primary Care Mental Health. 2009, London, UK: The Royal College of Psychiatrists
19.
Proctor EK, Landsverk J, Aarons G, Chambers D, Glisson C, Mittman B: Implementation research in mental health services: an emerging science with conceptual, methodological, and training challenges. Adm Policy Ment Health. 2009, 36 (1): 24-34. 10.1007/s10488-008-0197-4.CrossRefPubMed
20.
Canadian Psychiatric Association: Clinical practice guidelines: Management of anxiety disorders. Can J Psychiatry. 2006, 51 (Suppl 2): 1-93.
21.
Lam RW, Kennedy SH, Grigoriadis S, McIntyre RS, Milev R, Ramasubbu R, Parikh SV, Patten SB, Ravindran AV, Canadian Network for Mood and Anxiety Treatments (CANMAT): Canadian Network for Mood and Anxiety Treatments (CANMAT) clinical guidelines for the management of major depressive disorder in adults. III. Pharmacotherapy. J Affect Disord. 2009, 117 (Suppl 1): 26-43.CrossRef
22.
Parikh SV, Segal ZV, Grigoriadis S, Ravindran AV, Kennedy SH, Lam RW, Patten SB, Canadian Network for Mood and Anxiety Treatments (CANMAT): Canadian Network for Mood and Anxiety Treatments (CANMAT) clinical guidelines for the management of major depressive disorder in adults. II. Psychotherapy alone or in combination with antidepressant medication. J Affect Disord. 2009, 117 (Suppl 1): 15-25.CrossRef
23.
Roberge P, Fournier L, Duhoux A, Nguyen CT, Smolders M: Mental health service use and treatment adequacy for anxiety disorders in Canada. Soc Psychiatry Psychiatr Epidemiol. 2011, 46 (4): 321-330. 10.1007/s00127-010-0186-2.CrossRefPubMed
24.
Duhoux A, Fournier L, Nguyen CT, Roberge P, Beveridge R: Guideline concordance of treatment for depressive disorders in Canada. Soc Psychiatry Psychiatr Epidemiol. 2009, 44 (5): 385-392. 10.1007/s00127-008-0444-8.CrossRefPubMed
25.
Stein MB, Roy-Byrne P, Craske MG, Campbell-Sills L, Lang AJ, Golinelli D, Rose RD, Bystritsky A, Sullivan G, Sherbourne CD: Quality of and patient satisfaction with primary health care for anxiety disorders. J Clin Psychiatry. 2011, 72 (7): 970-976. 10.4088/JCP.09m05626blu.CrossRefPubMedPubMedCentral
26.
Wang PS, Angermeyer M, Borges G, Bruffaerts R, Tat CW, Fayyad J, Gureje O, Haro JM, Huang Y, Kessler RC, Kovess V, Levinson D, Nakane Y, Oakley Brown MA, Ormel JH, Posada-Villa J, Alonso J, Lee S, Heeringa S, Pennell BE, Chatterji S, Ustun TB, de GG: Delay and failure in treatment seeking after first onset of mental disorders in the World Health Organization’s World Mental Health Survey Initiative. World Psychiatry. 2007, 6 (3): 177-185.PubMedPubMedCentral
27.
Fernandez A, Haro JM, Martinez-Alonso M, Demyttenaere K, Brugha TS, Autonell J, de Girolamo G, Bernert S, Lepine JP, Alonso J: Treatment adequacy for anxiety and depressive disorders in six European countries. Br J Psychiatry. 2007, 190: 172-173. 10.1192/bjp.bp.106.023507.CrossRefPubMed
28.
Prins MA, Verhaak PF, Smolders M, Laurant MG, van der Meer K, Spreeuwenberg P, van Marwijk HW, Penninx BW, Bensing JM: Patient factors associated with guideline-concordant treatment of anxiety and depression in primary care. J Gen Intern Med. 2010, 25 (7): 648-655. 10.1007/s11606-009-1216-1.CrossRefPubMedPubMedCentral
29.
Duhoux A, Fournier L, Gauvin L, Roberge P: Quality of care for major depression and its determinants: a multilevel analysis. BMC Psychiatry. 2012, 12 (1): 142-10.1186/1471-244X-12-142.CrossRefPubMedPubMedCentral
30.
Houle J, Beaulieu MD, Lesperance F, Frasure-Smith N, Lambert J: Inequities in medical follow-up for depression: a population-based study in Montreal. Psychiatr Serv. 2010, 61 (3): 258-263. 10.1176/appi.ps.61.3.258.CrossRefPubMed
31.
Stein MB, Sherbourne CD, Craske MG, Means-Christensen A, Bystritsky A, Katon W, Sullivan G, Roy-Byrne PP: Quality of care for primary care patients with anxiety disorders. Am J Psychiatry. 2004, 161 (12): 2230-2237. 10.1176/appi.ajp.161.12.2230.CrossRefPubMed
32.
Wang PS, Lane M, Olfson M, Pincus HA, Wells KB, Kessler RC: Twelve-month use of mental health services in the United States: results from the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005, 62 (6): 629-640. 10.1001/archpsyc.62.6.629.CrossRefPubMed
33.
Roy-Byrne PP, Wagner AW, Schraufnagel TJ: Understanding and treating panic disorder in the primary care setting. J Clin Psychiatry. 2005, 6 (Suppl 4): 16-22.
34.
Collins KA, Westra HA, Dozois DJA, Burns DD: Gaps in accessing treatment for anxiety and depression: challenges for the delivery of care. Clin Psychol Rev. 2004, 24 (5): 583-616. 10.1016/j.cpr.2004.06.001.CrossRefPubMed
35.
Katon WJ, Seelig M: Population-based care of depression: team care approaches to improving outcomes. J Occup Environ Med. 2008, 50 (4): 459-467. 10.1097/JOM.0b013e318168efb7.CrossRefPubMed
36.
Grol R, Wensing M, Eccles M: Improving Patient Care. The Implementation of Change in Clinical Practice. 2005, Oxford: Elsevier
37.
Gilbody S, Whitty P, Grimshaw J, Thomas R: Educational and organizational interventions to improve the management of depression in primary care: a systematic review. JAMA. 2003, 289 (23): 3145-3151. 10.1001/jama.289.23.3145.CrossRefPubMed
38.
Smolders M, Laurant M, Roberge P, van Balkom A, van Rijswijk E, Bower P, Grol R: Knowledge transfer and improvement of primary and ambulatory care for patients with anxiety. Can J Psychiatry. 2008, 53 (5): 277-293.PubMed
39.
Cape J, Whittington C, Bower P: What is the role of consultation-liaison psychiatry in the management of depression in primary care? A systematic review and meta-analysis. Gen Hosp Psychiatry. 2010, 32 (3): 246-254. 10.1016/j.genhosppsych.2010.02.003.CrossRefPubMed
40.
Gilbody S, Bower P, Fletcher J, Richards D, Sutton AJ: Collaborative care for depression: a cumulative meta-analysis and review of longer-term outcomes. Arch Intern Med. 2006, 166 (21): 2314-2321. 10.1001/archinte.166.21.2314.CrossRefPubMed
41.
Williams JW, Gerrity M, Holsinger T, Dobscha S, Gaynes B, Dietrich A: Systematic review of multifaceted interventions to improve depression care. Gen Hosp Psychiatry. 2007, 29 (2): 91-116. 10.1016/j.genhosppsych.2006.12.003.CrossRefPubMed
42.
Kates N, Mazowita G, Lemire F, Jayabarathan A, Bland R, Selby P, Isomura T, Craven M, Gervais M, Audet D: The evolution of collaborative mental health care in Canada: A shared vision for the future. Can J Psychiatry. 2011, 56 (5): 1-10.
43.
Archer J, Bower P, Gilbody S, Lovell K, Richards D, Gask L, Dickens C, Coventry P: Collaborative care for depression and anxiety problems. Cochrane Database Syst Rev. 2012, 10: CD006525-PubMed
44.
Christensen H, Griffiths KM, Gulliver A, Clack D, Kljakovic M, Wells L: Models in the delivery of depression care: a systematic review of randomised and controlled intervention trials. BMC Fam Pract. 2008, 9: 25-10.1186/1471-2296-9-25.CrossRefPubMedPubMedCentral
45.
Katon W, Von Korff M, Lin E, Simon G: Rethinking practitioner roles in chronic illness: the specialist, primary care physician, and the practice nurse. Gen Hosp Psychiatry. 2001, 23 (3): 138-144. 10.1016/S0163-8343(01)00136-0.CrossRefPubMed
46.
Gensichen J, Beyer M, Muth C, Gerlach FM, Von KM, Ormel J: Case management to improve major depression in primary health care: a systematic review. Psychol Med. 2006, 36 (1): 7-14.CrossRefPubMed
47.
Franx G, Oud M, de Lange J, Wensing M, Grol R: Implementing a stepped-care approach in primary care: results of a qualitative study. Implement Sci. 2012, 7 (1): 8-10.1186/1748-5908-7-8.CrossRefPubMedPubMedCentral
48.
49.
50.
Wagner EH: Chronic disease management: what will it take to improve care for chronic illness?. Eff Clin Pract. 1998, 1 (1): 2-4.PubMed
51.
Wagner EH, Austin BT, Davis C, Hindmarsh M, Schaefer J, Bonomi A: Improving chronic illness care: translating evidence into action. Health Aff (Millwood). 2001, 20 (6): 64-78. 10.1377/hlthaff.20.6.64.CrossRef
52.
Tsai AC, Morton SC, Mangione CM, Keeler EB: A meta-analysis of interventions to improve care for chronic illnesses. Am J Manag Care. 2005, 11 (8): 478-488.PubMedPubMedCentral
53.
Woltmann E, Grogan-Kaylor A, Perron B, Georges H, Kilbourne AM, Bauer MS: Comparative effectiveness of collaborative chronic care models for mental health conditions across primary, specialty, and behavioral health care settings: systematic review and meta-analysis. Am J Psychiatry. 2012, 169 (8): 790-804. 10.1176/appi.ajp.2012.11111616.CrossRefPubMed
54.
Ministère de la Santé et des Services sociaux du Québec: Plan d’action en santé mentale 2005–2010 - La force des liens. 2005, Québec: Gouvernement du Québec
55.
Ministère de la Santé et des Services sociaux: Orientations relatives à l’organisation des soins et des services offerts à la clientèle adulte par les équipes en santé mentale de première ligne en CSSS. 2011, Québec: Gouvernement du Québec
56.
Kitson A, Harvey G, McCormack B: Enabling the implementation of evidence based practice: a conceptual framework. Qual Health Care. 1998, 7 (3): 149-158. 10.1136/qshc.7.3.149.CrossRefPubMedPubMedCentral
57.
Rycroft-Malone J, Kitson A, Harvey G, McCormack B, Seers K, Titchen A, Estabrooks C: Ingredients for change: revisiting a conceptual framework. Qual Saf Health Care. 2002, 11 (2): 174-180. 10.1136/qhc.11.2.174.CrossRefPubMedPubMedCentral
58.
Greenhalgh T, Robert G, Macfarlane F, Bate P, Kyriakidou O: Diffusion of innovations in service organizations: systematic review and recommendations. Milbank Q. 2004, 82 (4): 581-629. 10.1111/j.0887-378X.2004.00325.x.CrossRefPubMedPubMedCentral
59.
VanDeusen LC, Engle RL, Holmes SK, Parker VA, Petzel RA, Nealon Seibert M, Shwartz M, Sullivan JL: Strengthening organizations to implement evidence-based clinical practices. Health Care Manage Rev. 2010, 35 (3): 235-245.CrossRef
60.
Alexander J, A., Hearld L, R: The science of quality improvement implementation: developing capacity to make a difference. Med Care. 2011, 49: S6-20.CrossRef
61.
Yin RK: Case Study Research: Design and Methods. 2009, Thousand Oaks, CA: Sage
62.
Baker GR: The contribution of case study research to knowledge of how to improve quality of care. BMJ Qual Saf. 2011, 20 (Suppl 1): 30-35. 10.1136/bmjqs.2010.046490.CrossRef
63.
Breton M, Levesque JF, Pineault R, Hogg W: Primary care reform: Can Quebec’s family medicine group model benefit from the experience of Ontario’s family health teams?. Healthc Policy. 2011, 7 (2): e122-35.PubMedPubMedCentral
64.
65.
Graham ID, Logan J, Harrison MB, Straus SE, Tetroe J, Caswell W, Robinson N: Lost in knowledge translation: time for a map?. J Contin Educ Health Prof. 2006, 26 (1): 13-24. 10.1002/chp.47.CrossRefPubMed
66.
Kilbourne AM, Keyser D, Pincus HA: Challenges and opportunities in measuring the quality of mental health care. Can J Psychiatry. 2010, 55 (9): 549-557.PubMedPubMedCentral
67.
Dorr D, Bonner LM, Cohen AN, Shoai RS, Perrin R, Chaney E, Young AS: Informatics systems to promote improved care for chronic illness: a literature review. J Am Med Inform Assoc. 2007, 14 (2): 156-163. 10.1197/jamia.M2255.CrossRefPubMedPubMedCentral
68.
Paré G, Sicotte C, Jaana M, Girouard D: Prioritizing the risk factors influencing the success of clinical information system projects. A Delphi study in Canada. Methods Inf Med. 2008, 47 (3): 251-259.PubMed
69.
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders. 4th edition, text revised. 2000, Washington, DC: American Psychiatric Association
70.
Kennedy SH, Milev R, Giacobbe P, Ramasubbu R, Lam RW, Parikh SV, Patten SB, Ravindran AV, Canadian Network for Mood and Anxiety Treatments (CANMAT): Canadian Network for Mood and Anxiety Treatments (CANMAT) Clinical guidelines for the management of major depressive disorder in adults. J Affect Disord. 2009, 117 (Suppl 1): 44-53.CrossRef
71.
National Institute for Health and Clinical Excellence (NICE): Depression: the Treatment and Management of Depression in Adults (updated edition). National Clinical Practice Guideline 90. 2009, UK: The British Psychological Society & The Royal College of Psychiatrists
72.
Spitzer RL, Kroenke K, Williams JB, Löwe B: A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006, 166 (10): 1092-1097. 10.1001/archinte.166.10.1092.CrossRefPubMed
73.
Kroenke K, Spitzer RL, Williams JB: The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med. 2001, 16 (9): 606-613. 10.1046/j.1525-1497.2001.016009606.x.CrossRefPubMedPubMedCentral
74.
Sheehan DV, Harnett-Sheehan K, Spann ME, Thompson HF, Prakash A: Assessing remission in major depressive disorder and generalized anxiety disorder clinical trials with the discan metric of the Sheehan disability scale. Int Clin Psychopharmacol. 2011, 26 (2): 75-83. 10.1097/YIC.0b013e328341bb5f.CrossRefPubMed
75.
Sheehan KH, Sheehan DV: Assessing treatment effects in clinical trials with the discan metric of the Sheehan Disability Scale. Int Clin Psychopharmacol. 2008, 23 (2): 70-83. 10.1097/YIC.0b013e3282f2b4d6.CrossRefPubMed
76.
77.
Speroff T, O’Connor G: Study designs for PDSA quality improvement research. Q Manage Health Care. 2004, 13 (1): 17-32.CrossRef
78.
Langley GL, Moen RD, Nolan KM, Nolan TW, Norman CL, Provost LP: The Improvement Guide: A Practical Approach to Enhancing Organizational Performance: 2nd ed. 2009, San Francisco: Jossey-Bass Publishers
79.
Tashakkori A, Teddlie CE: Mixed Methodology: Combining Qualitative and Quantitative Approaches. 2003, Thousand Oaks: CA: Sage
80.
Miles MB, Huberman AM: Qualitative Data Analysis. 2010, Thousand Oaks: CA: Sage
81.
Bonomi AE, Wagner EH, Glasgow RE, VonKorff M: Assessment of chronic illness care (ACIC): a practical tool to measure quality improvement. Health Serv Res. 2002, 37 (3): 791-820. 10.1111/1475-6773.00049.CrossRefPubMedPubMedCentral
82.
Gagnon M: Knowledge dissemination and exchange of knowledge. Knowledge Translation in Health Care: Moving from Evidence to Practice. Edited by: Strauss S, Tetroe J, Graham ID. 2009, UK: Wiley-Blackwell, 235-245.
83.
Graham ID, Bick D, Tetroe J, Straus SE, Harrison MB: Measuring outcomes of evidence-based practice: Distinguishing between knowledge use and its impact. Evaluating the Impact of Implementing Evidence-Based Practice. Edited by: Bick D, Graham ID. 2010, UK: Wiley-Blackwell, 18-37.
Metadata
Title
Implementing a knowledge application program for anxiety and depression in community-based primary mental health care: a multiple case study research protocol
Authors
Pasquale Roberge
Louise Fournier
Hélène Brouillet
Catherine Hudon
Janie Houle
Martin D Provencher
Jean-Frédéric Lévesque
Publication date
01-12-2013
Publisher
BioMed Central
Published in
Implementation Science / Issue 1/2013
Electronic ISSN: 1748-5908
DOI
https://doi.org/10.1186/1748-5908-8-26

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