Pasquale Roberge1, Louise Fournier2, Hélène Brouillet3, André Delorme4, Clément Beaucage5, Rodrigue Côté6, Pierre Demers7, Michel Gervais4, France Laflamme8, Louise Latulippe4, André Marchand9, Simon Patry10, Suzanne Pelchat11, Martin D Provencher12, Jean-Rémy Provost13, David Robitaille14, Anne-Marie Cloutier2. 1. Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Canada. 2. Research Centre of the Centre hospitalier de l'Université de Montréal (CRCHUM), Montréal, Canada. 3. Institut national de santé publique du Québec, Montréal, Canada. 4. Ministère de la Santé et des Services sociaux du Québec, Québec, Canada. 5. Direction régionale de la santé publique, Agence de la santé et des services sociaux de la Capitale-Nationale, Québec, Canada. 6. Centre de santé et de services sociaux de la Vieille-Capitale, Québec, Canada. 7. Centre de santé et de services sociaux du Sud-Ouest-Verdun, Montréal, Canada. 8. Ordre des infirmières et infirmiers du Québec, Montréal, Canada. 9. Department of Psychology, Université du Québec à Montréal, Montréal, Canada. 10. Institut universitaire en santé mentale de Québec, Québec, Canada. 11. Centre de santé et de services sociaux de Québec Nord, Québec, Canada. 12. School of Psychology, Université Laval, Québec, Canada. 13. Revivre - Quebec Anxiety, Depressive and Bipolar Disorder Support Association, Montréal, Canada. 14. Centre de santé et de services sociaux Pierre-Boucher, Longueuil, Canada.
Abstract
RATIONALE, AIMS AND OBJECTIVES: Mental health services for patients with a major depressive disorder are commonly delivered by primary care. To support the uptake of clinical practice guidelines in primary care, we developed and disseminated a practice protocol for depression tailored for a multidisciplinary audience of primary mental health care providers with the ADAPTE methodology. The research questions addressed in this study aimed at examining the experience of the development process of a mental health practice protocol in terms of adaptation, facilitation and implementation. METHODS: We present a descriptive case study of the development and implementation of a practice protocol for major depressive disorder for primary mental health care in the organizational and cultural context of the province of Québec (Canada), following the steps of the ADAPTE methodology. An expert committee composed of general practitioners, mental health specialists, health care administrators and decision makers at regional and provincial levels participated in the protocol development process. RESULTS: The practice protocol was based on two clinical practice guidelines: the NICE guideline on the treatment and management of depression in adults (2009, 2010) and the Canadian Network for Mood and Anxiety Treatments clinical guidelines for the management of major depressive disorder in adults (2009). A stepped care model was embedded in the protocol to facilitate the implementation of clinical recommendations in primary mental health care. A multifaceted dissemination strategy was used to support the uptake of the protocol recommendations in clinical practice. CONCLUSIONS: The ADAPTE methodology provided structure, rigour and efficiency to the trans-contextual adaptation of guideline recommendations. We will share the challenges associated with the adaptation of clinical recommendations and organizational strategies for a mental health guideline, and the dissemination of the practice protocol in primary care.
RATIONALE, AIMS AND OBJECTIVES: Mental health services for patients with a major depressive disorder are commonly delivered by primary care. To support the uptake of clinical practice guidelines in primary care, we developed and disseminated a practice protocol for depression tailored for a multidisciplinary audience of primary mental health care providers with the ADAPTE methodology. The research questions addressed in this study aimed at examining the experience of the development process of a mental health practice protocol in terms of adaptation, facilitation and implementation. METHODS: We present a descriptive case study of the development and implementation of a practice protocol for major depressive disorder for primary mental health care in the organizational and cultural context of the province of Québec (Canada), following the steps of the ADAPTE methodology. An expert committee composed of general practitioners, mental health specialists, health care administrators and decision makers at regional and provincial levels participated in the protocol development process. RESULTS: The practice protocol was based on two clinical practice guidelines: the NICE guideline on the treatment and management of depression in adults (2009, 2010) and the Canadian Network for Mood and Anxiety Treatments clinical guidelines for the management of major depressive disorder in adults (2009). A stepped care model was embedded in the protocol to facilitate the implementation of clinical recommendations in primary mental health care. A multifaceted dissemination strategy was used to support the uptake of the protocol recommendations in clinical practice. CONCLUSIONS: The ADAPTE methodology provided structure, rigour and efficiency to the trans-contextual adaptation of guideline recommendations. We will share the challenges associated with the adaptation of clinical recommendations and organizational strategies for a mental health guideline, and the dissemination of the practice protocol in primary care.