title: 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 patients.
abstract: General 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.
  
  
  
  The 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.
  
  
  
  Recovery-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.
  
  
  
  Australian and New Zealand Clinical Trial Registry ( ACTRN12614001312639 ). Registered: 8 August 2014.
authors.affiliation: Southern Synergy, Department of Psychiatry, Monash University, 126 Cleeland St, Dandenong, VIC, Australia.|Royal District Nursing Service Institute, 31 Alma Rd, St Kilda, VIC, Australia.
authors.forename: Joanne C
authors.initials: JC
authors.lastname: Enticott
authors.affiliation: Southern Synergy, Department of Psychiatry, Monash University, 126 Cleeland St, Dandenong, VIC, Australia.
authors.forename: Frances
authors.initials: F
authors.lastname: Shawyer
authors.affiliation: Mind Australia, Heidelberg, VIC, Australia.|Melbourne School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia.
authors.forename: Lisa
authors.initials: L
authors.lastname: Brophy
authors.affiliation: School of Primary Health Care, Monash University, Notting Hill Campus, Victoria, Australia.|Southern Academic Primary Care Research Unit, Monash University, Notting Hill, Victoria, Australia.
authors.forename: Grant
authors.initials: G
authors.lastname: Russell
authors.affiliation: School of Primary Health Care, Monash University Peninsula Campus, Frankston, VIC, Australia.
authors.forename: Ellie
authors.initials: E
authors.lastname: Fossey
authors.affiliation: Department of Econometrics and Business Statistics, Monash University, Melbourne, VIC, Australia.
authors.forename: Brett
authors.initials: B
authors.lastname: Inder
authors.affiliation: School of Primary Health Care, Monash University, Notting Hill Campus, Victoria, Australia.
authors.forename: Danielle
authors.initials: D
authors.lastname: Mazza
authors.affiliation: School of Primary Health Care, Monash University, Notting Hill Campus, Victoria, Australia.|Southern Academic Primary Care Research Unit, Monash University, Notting Hill, Victoria, Australia.
authors.forename: Shiva
authors.initials: S
authors.lastname: Vasi
authors.affiliation: Graduate School of Business and Law, RMIT University, Melbourne, VIC, Australia.
authors.forename: Penelope June
authors.initials: PJ
authors.lastname: Weller
authors.affiliation: College of Business, Victoria University, Melbourne, VIC, Australia.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Wilson-Evered
authors.affiliation: Southern Synergy, Department of Psychiatry, Monash University, 126 Cleeland St, Dandenong, VIC, Australia.
authors.forename: Vrinda
authors.initials: V
authors.lastname: Edan
authors.affiliation: Southern Synergy, Department of Psychiatry, Monash University, 126 Cleeland St, Dandenong, VIC, Australia. graham.meadows@monash.edu.|Melbourne School of Population and Global Health, University of Melbourne, Parkville, VIC, Australia. graham.meadows@monash.edu.|Monash Health, Melbourne, VIC, Australia. graham.meadows@monash.edu.
authors.forename: Graham
authors.initials: G
authors.lastname: Meadows
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D058005:General Practitioners / Q000458:organization & administration*; D006801:Humans; D008297:Male; D001523:Mental Disorders / Q000628:therapy*; D008605:Mental Health Services / Q000458:organization & administration*; D011320:Primary Health Care / Q000458:organization & administration*; D058996:Quality Improvement; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D014739:Victoria
keywords: Complex Intervention; General Practitioners; Mental Health; Primary Care; Psychiatry; Randomized Controlled Trial (RCT); Recovery; Recovery-oriented Practice; Training