title: Incentives and disincentives for treating of depression and anxiety in Ontario Family Health Teams: protocol for a grounded theory study.
abstract: There is strong consensus that prevention and management of common mental disorders (CMDs) should occur in primary care and evidence suggests that treatment of CMDs in these settings can be effective. New interprofessional team-based models of primary care have emerged that are intended to address problems of quality and access to mental health services, yet many people continue to struggle to access care for CMDs in these settings. Insufficient attention directed towards the incentives and disincentives that influence care for CMDs in primary care, and especially in interprofessional team-based settings, may have resulted in missed opportunities to improve care quality and control healthcare costs. Our research is driven by the hypothesis that a stronger understanding of the full range of incentives and disincentives at play and their relationships with performance and other contextual factors will help stakeholders identify the critical levers of change needed to enhance prevention and management of CMDs in interprofessional primary care contexts. Participant recruitment began in May 2016.
  
  
  
  An explanatory qualitative design, based on a constructivist grounded theory methodology, will be used. Our study will be conducted in the Canadian province of Ontario, a province that features a widely implemented interprofessional team-based model of primary care. Semistructured interviews will be conducted with a diverse range of healthcare professionals and stakeholders that can help us understand how various incentives and disincentives influence the provision of evidence-based collaborative care for CMDs. A final sample size of 100 is anticipated. The protocol was peer reviewed by experts who were nominated by the funding organisation.
  
  
  
  The model we generate will shed light on the incentives and disincentives that are and should be in place to support high-quality CMD care and help stimulate more targeted, coordinated stakeholder responses to improving primary mental healthcare quality.
authors.affiliation: Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Rachelle
authors.identifier: 0000-0002-5666-1946
authors.initials: R
authors.lastname: Ashcroft
authors.affiliation: CHU de Quebec Research Centre, Quebec City, Quebec, Canada.|Department of Family Medicine and Emergency Medicine, Laval University, Quebec City, Quebec, Canada.
authors.forename: Matthew
authors.initials: M
authors.lastname: Menear
authors.affiliation: Mental Health and Addiction Program, St. Joseph's Health Centre, Toronto, Ontario, Canada.|Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
authors.forename: Jose
authors.initials: J
authors.lastname: Silveira
authors.affiliation: C.T. Lamont Primary Health Care Research Centre, Bruyere Research Institute, Ottawa, Ontario, Canada.
authors.forename: Simone
authors.initials: S
authors.lastname: Dahrouge
authors.affiliation: Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.|Wellesley Institute, Toronto, Ontario, Canada.|Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
authors.forename: Kwame
authors.initials: K
authors.lastname: McKenzie
mesh_terms: D001007:Anxiety / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D032921:Consensus; D003299:Cooperative Behavior; D003863:Depression / Q000175:diagnosis* / Q000453:epidemiology / Q000628:therapy; D005192:Family Health; D005260:Female; D066296:Grounded Theory; D006801:Humans; D007400:Interprofessional Relations; D008297:Male; D008605:Mental Health Services / Q000458:organization & administration; D009042:Motivation; D009864:Ontario / Q000453:epidemiology; D011320:Primary Health Care / Q000458:organization & administration; D011787:Quality of Health Care / Q000592:standards*
keywords: DISINCENTIVES; INCENTIVES; MENTAL HEALTH; PRIMARY CARE; PROTOCOL; QUALITATIVE RESEARCH