title: Implementing a knowledge application program for anxiety and depression in community-based primary mental health care: a multiple case study research protocol.
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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Département de médecine de famille et de médecine d'urgence, Faculté de médecine et des sciences de la santé, Université de Sherbrooke, 3001, 12e Avenue Nord, Sherbrooke, Québec, Canada. pasquale.roberge@usherbrooke.ca
authors.forename: Pasquale
authors.initials: P
authors.lastname: Roberge
authors.forename: Louise
authors.initials: L
authors.lastname: Fournier
authors.forename: Hélène
authors.initials: H
authors.lastname: Brouillet
authors.forename: Catherine
authors.initials: C
authors.lastname: Hudon
authors.forename: Janie
authors.initials: J
authors.lastname: Houle
authors.forename: Martin D
authors.initials: MD
authors.lastname: Provencher
authors.forename: Jean-Frédéric
authors.initials: JF
authors.lastname: Lévesque
mesh_terms: D001008:Anxiety Disorders / Q000628:therapy*; D016022:Case-Control Studies; D003156:Community Mental Health Services / Q000458:organization & administration* / Q000592:standards; D003695:Delivery of Health Care / Q000458:organization & administration / Q000592:standards; D003865:Major Depressive Disorder / Q000628:therapy*; D004059:Diffusion of Innovation; D007722:Health Knowledge, Attitudes, Practice; D006284:Health Plan Implementation; D006801:Humans; D010348:Patient Care Team / Q000458:organization & administration / Q000592:standards; D011320:Primary Health Care / Q000458:organization & administration* / Q000592:standards; D015397:Program Evaluation; D011446:Prospective Studies; D058996:Quality Improvement; D011787:Quality of Health Care; D011792:Quebec