title: Evaluation of a mental health training intervention for multidisciplinary teams in primary care in Brazil: a pre- and posttest study.
abstract: OBJECTIVE
  The aim of this research was to investigate whether a training intervention to enhance collaboration between mental health and primary care professionals improved the detection and management of mental health problems in primary health care in four large cities in Brazil. The training intervention was a multifaceted program over 96 h focused on development of a shared care model.
  
  
  METHODS
  A quasiexperimental study design was undertaken with assessment of performance by nurse and general practitioners (GPs) pre- and postintervention. Rates of recognition of mental health disorders (compared with the General Health Questionnaire) were the primary outcome, while self-reports of patient-centered care, psychosocial interventions and referral were the secondary outcomes.
  
  
  RESULTS
  Six to 8 months postintervention, no changes were observed in terms of rate of recognition across the entire sample. Nurses significantly increased their recognition rates (from 23% to 39%, P=.05), while GPs demonstrated a significant decrease (from 42% to 30%, P=.04). There were significant increases in reports of patient-centered care, but no changes in other secondary outcomes.
  
  
  CONCLUSIONS
  Training professionals in a shared care model was not associated with consistent improvements in the recognition or management of mental health problems. Although instabilities in the local context may have contributed to the lack of effects, wider changes in the system of care may be required to augment training and encourage reliable changes in behavior, and more specific educating models are necessary.
authors.affiliation: Universidade Federal de Sao Paulo, CEP 04021-070 Sao Paulo, Brazil. daniel.almeida.33@gmail.com
authors.forename: Daniel A
authors.initials: DA
authors.lastname: Goncalves
authors.forename: Sandra
authors.initials: S
authors.lastname: Fortes
authors.forename: Monica
authors.initials: M
authors.lastname: Campos
authors.forename: Dinarte
authors.initials: D
authors.lastname: Ballester
authors.forename: Flávia Batista
authors.initials: FB
authors.lastname: Portugal
authors.forename: Luis Fernando
authors.initials: LF
authors.lastname: Tófoli
authors.forename: Linda
authors.initials: L
authors.lastname: Gask
authors.forename: Jair
authors.initials: J
authors.lastname: Mari
authors.forename: Peter
authors.initials: P
authors.lastname: Bower
mesh_terms: D000328:Adult; D001938:Brazil; D002983:Clinical Competence; D003299:Cooperative Behavior; D004506:Education, Nursing / Q000379:methods; D005260:Female; D058005:General Practitioners / Q000193:education; D006282:Health Personnel / Q000193:education*; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000175:diagnosis*; D010348:Patient Care Team; D018802:Patient-Centered Care / Q000379:methods; D011320:Primary Health Care / Q000379:methods*; D012017:Referral and Consultation