The PULSAR primary care protocol: a stepped-wedge cluster randomized controlled trial to test a training intervention for general practitioners in recovery-oriented practice to optimize personal recovery in adult patientsReportar como inadecuado

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BMC Psychiatry

, 16:451

First Online: 20 December 2016Received: 16 November 2016Accepted: 01 December 2016


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.

KeywordsRecovery Recovery-oriented Practice Primary Care General Practitioners Mental Health Psychiatry Training Randomized Controlled Trial RCT Complex Intervention AbbreviationsANZCTRAustralian New Zealand Clinical Trials Registry

CIChief Investigator

cRCTCluster randomized control trial

GPMHTP-RGeneral practitioner mental health treatment plan-recovery

GUPIGeneral-practiceusers- perceived-need inventory

HRECHuman research ethics committee

ICCIntraclass correlation coefficient

LEAPLived experience advisory panel

MHSTMental health skills training

NHMRCNational health and medical research council

PARIHSPromoting action on research implementation in health services

PIPrincipal investigator

PULSARPrinciples unite local services assisting recovery

QPRQuestionnaire about the process of recovery

SWCRCTStepped-wedge cluster randomized controlled trial

WEMWBSWarwick-edinburgh mental well-being scale

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Autor: Joanne C. Enticott - Frances Shawyer - Lisa Brophy - Grant Russell - Ellie Fossey - Brett Inder - Danielle Mazza - Shiva 


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