Background
Primary mental health care services in the province of Quebec, Canada
Objectives
Methods
Study design
Ethical approval
Setting
Community-based mental health care teams
Organisations | ||||||
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Organisational characteristics
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Population | 139, 000 | 140, 000 | 220,000 | 245,000 | 75,000 | 55,000 |
Location | ||||||
Urban | X | X | ||||
Semi-urban | X | X | X | |||
Rural | X | |||||
University-affiliated | X | X | X | |||
Hospital integrated to the CSSS | X | X | X | X | X | |
Full-time personnel employed at the CMHT
| 30.1 | 22.3 | 6.8 | 18 | 12.3 | 5.6 |
Nurses | 5.6 | 4 | 3 | 5.6 | 2.8 | 2 |
Social workers | 12.5 | 9.8 | 2 | 4.8 | 3.4 | 1.8 |
Psychologists | 10.4 | 7.2 | 1.8 | 6.8 | 5.1 | 1.8 |
Other health professionals | 1.6 | 0.3 | 0.8 | 1 | ||
OT | OC | HRA | ED | |||
GPs | X | |||||
Consulting psychiatrists | X | X | X | X | X | X |
Clinical coordinator | X | X | X | X | ||
Description of the associated medical clinic
| 1 | 1 | 2 | 1 | 1 | 1 |
Family medicine group | X | X | X | X | X | |
Family medicine unit | X | X | X | |||
Network clinic | X | |||||
Composition of local work committee (total)
| 7 | 10 | 14 | 10 | 11 | 11 |
Health care administrator | 1*
| 1*
| 1 | 1*
| 4*
| 1 |
GPs | 1 | 1 | 2 | 2 | 1 | 1 |
Nurses | 1 | 2 | 2 | 2 | 2 | 3 |
Psychologists | 2 | 2 | 2 | 2 | 1 | 2 |
Social workers | 2 | 2 | 1 | 1 | 2 | |
Clinical coordinator | 1 | 1 | 2 | |||
Psychiatrists | 2 | 2 | ||||
Project manager/Research agent | 2*
| 1*
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Other health professionals | 1 | |||||
Members of other organisations | 1 | 2 | 1 |
Description of the intervention
Phase 1: The knowledge application program
The meetings and training modules
Module | Title, chronic care model components [CCM] *, Objective | Content |
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1 |
The context [ CCM: HSO, CRP ]: To understand the principles that support the implementation of the knowledge application program, the bases of the knowledge application program, and the key policies and orientations that directed the structuring of mental health services in Quebec, Canada. | 1. Common mental disorders in primary care |
3. Quality of care for depressive and anxiety disorders | ||
4. The organization of the health care system | ||
2 |
The knowledge application program [ CCM: HSO, DSD, DS, CIS, SM, CRP ]: To enable participants to understand the scope of the knowledge application program and know the different stages of its deployment. | 1. Project and objectives |
2. Knowledge application program | ||
3. Developing and implementing a local quality improvement plan | ||
3 |
The implementation of changes in clinical practice [CCM: HSO, DSD, DS]: To provide participants with a systemic view of the implementation of changes in an organizational context. To understand the role played by the local working committee and identify key stakeholders. | |
2. Knowledge application in the Health and Social Services Centre context | ||
3. The Knowledge-to-action cycle[65] | ||
4 |
The stepped-care model [CCM: DSD, CIS]: Participants will be guided by the principles and concepts presented in order to review their services and care pathways; the role and responsibilities of the various care providers throughout the care pathway will also be reviewed. | 1. Delivery system design |
2. Stepped-care : description and examples | ||
3. Lessons from the literature | ||
5 |
Clinical decision support - Clinical practice guidelines [CCM: DS]: Participants will have a common understanding of clinical practice guidelines, as well as their benefits and limitations, and know how to refer to them in their clinical decision making. | 1. Clinical decision support |
2. Clinical practice guidelines | ||
3. Benefits and limitations related to clinical practice guidelines | ||
4. Where to find clinical practice guidelines | ||
6 |
Working together: how to implement strategies for interprofessional collaboration [CCM: DSD, DS]: To enable settings to identify strategies to offer complementary services, ensure coordination of care, foster teamwork and define modalities that encourage mutual support between providers. | 1. Interprofessional collaboration |
2. A continuum of collaborative practices | ||
3. What is collaborative care in mental health? | ||
4. Simple changes for depression in primary care | ||
5. Collaborative care models for anxiety and depressive disorders | ||
6. Case management - a key element of collaborative care | ||
7 |
Productive interactions between the patient and health care team [CCM: SM]: Identify the tools and strategies that best enable care providers to offer accurate information to patients about their health including motivational interviewing and shared decision-making. | 1. The role of productive interactions in the Chronic Care Model |
2. Patient education | ||
3. Motivational interviewing | ||
4. Shared decision-making: a key to productive interactions | ||
5. Communication strategies: The communication cycle | ||
8 |
Self-management support [CCM: SM]: To promote the various self-management tools and identify strategies which encourage the implementation of interventions aiming to support self-care among people with depression and/or anxiety disorders. | 1. Self-management support: what and how? |
2. The effectiveness of self-management strategies for the treatment of depression and anxiety disorders | ||
3. The characteristics of a good self-manager | ||
4. What helps patients succeed in the management of their care | ||
5. The right form of self-management support for the right patient | ||
6. Two self-management program examples: | ||
• Self-management depression workshop | ||
• Self-care depression guide | ||
9 |
Low-intensity interventions and the various group interventions [CCM: DS, SM]: To provide examples of promising practices and help participants to identify low-intensity interventions that could be offered to people with depression and/or anxiety disorders. To differentiate the various forms of group interventions that can be offered to patients such as group therapy, psychoeducational groups, and self-help and support groups. | 1.Low-intensity interventions |
2. Examples of low-intensity interventions | ||
The different group interventions | ||
10 |
Clinical Information Systems [CCM: CIS]: To demonstrate the importance of clinical information systems in patient monitoring. | 1. What is a clinical information system? |
2. The functions of a clinical information system | ||
3. The indicators to include in the clinical information system | ||
4. The patient follow-up worksheet |