title: A provincial adaptation of clinical practice guidelines for depression in primary care: a case illustration of the ADAPTE method.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Family Medicine and Emergency Medicine, Université de Sherbrooke, Sherbrooke, Canada.
authors.forename: Pasquale
authors.initials: P
authors.lastname: Roberge
authors.affiliation: Research Centre of the Centre hospitalier de l'Université de Montréal (CRCHUM), Montréal, Canada.
authors.forename: Louise
authors.initials: L
authors.lastname: Fournier
authors.affiliation: Institut national de santé publique du Québec, Montréal, Canada.
authors.forename: Hélène
authors.initials: H
authors.lastname: Brouillet
authors.affiliation: Ministère de la Santé et des Services sociaux du Québec, Québec, Canada.
authors.forename: André
authors.initials: A
authors.lastname: Delorme
authors.affiliation: Direction régionale de la santé publique, Agence de la santé et des services sociaux de la Capitale-Nationale, Québec, Canada.
authors.forename: Clément
authors.initials: C
authors.lastname: Beaucage
authors.affiliation: Centre de santé et de services sociaux de la Vieille-Capitale, Québec, Canada.
authors.forename: Rodrigue
authors.initials: R
authors.lastname: Côté
authors.affiliation: Centre de santé et de services sociaux du Sud-Ouest-Verdun, Montréal, Canada.
authors.forename: Pierre
authors.initials: P
authors.lastname: Demers
authors.affiliation: Ministère de la Santé et des Services sociaux du Québec, Québec, Canada.
authors.forename: Michel
authors.initials: M
authors.lastname: Gervais
authors.affiliation: Ordre des infirmières et infirmiers du Québec, Montréal, Canada.
authors.forename: France
authors.initials: F
authors.lastname: Laflamme
authors.affiliation: Ministère de la Santé et des Services sociaux du Québec, Québec, Canada.
authors.forename: Louise
authors.initials: L
authors.lastname: Latulippe
authors.affiliation: Department of Psychology, Université du Québec à Montréal, Montréal, Canada.
authors.forename: André
authors.initials: A
authors.lastname: Marchand
authors.affiliation: Institut universitaire en santé mentale de Québec, Québec, Canada.
authors.forename: Simon
authors.initials: S
authors.lastname: Patry
authors.affiliation: Centre de santé et de services sociaux de Québec Nord, Québec, Canada.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Pelchat
authors.affiliation: School of Psychology, Université Laval, Québec, Canada.
authors.forename: Martin D
authors.initials: MD
authors.lastname: Provencher
authors.affiliation: Revivre - Quebec Anxiety, Depressive and Bipolar Disorder Support Association, Montréal, Canada.
authors.forename: Jean-Rémy
authors.initials: JR
authors.lastname: Provost
authors.affiliation: Centre de santé et de services sociaux Pierre-Boucher, Longueuil, Canada.
authors.forename: David
authors.initials: D
authors.lastname: Robitaille
authors.affiliation: Research Centre of the Centre hospitalier de l'Université de Montréal (CRCHUM), Montréal, Canada.
authors.forename: Anne-Marie
authors.initials: AM
authors.lastname: Cloutier
mesh_terms: D002170:Canada; D002985:Clinical Protocols; D003865:Major Depressive Disorder / Q000175:diagnosis* / Q000628:therapy*; D019317:Evidence-Based Medicine; D006801:Humans; D007400:Interprofessional Relations; D017410:Practice Guidelines as Topic; D011320:Primary Health Care / Q000458:organization & administration*
keywords: ADAPTE methodology; clinical practice guidelines; dissemination; major depressive disorder