Implementing work-related Mental health guidelines in general PRacticE (IMPRovE): Protocol for a pragmatic stepped-wedged cluster-randomised controlled trial

Problem

In 2018, 61% of UK employees experienced mental health issues due to work or where work was a related factor. Internationally, the incidence of mental health conditions (MHCs) is similarly common. General practitioners (GPs) have an important and complex role in the recovery of patients with work-related MHCs. They undertake the initial assessment of patients, initiate a management plan and provide ongoing care. They also provide advice to patients about compensation claims processes and make judgements about the work-relatedness of a MHC and a patient’s capacity to work. Many GPs are under-resourced and ill-equipped to deal with the considerable clinical uncertainties and system complexities they face in facilitating recovery and return-to-work for these patients. In response, our team has developed a new evidence-based clinical guideline on the diagnosis and management of work-related MHCs in general practice. This trial aims to test an implementation strategy for the clinical guideline.

Approach

We will undertake a pragmatic cluster randomised controlled trial using a stepped-wedge approach to evaluate whether the IMPRovE intervention (comprising academic detailing, resource provision, and support through a digital community of practice) improves implementation of the guideline in general practice, as well as outcomes for patients. We will assess GP practice at baseline, post-intervention (12 months) and follow-up (24 months). We will also assess health and return-to-work outcomes of participating patients at baseline, 6 months and 12 months following the initial GP consultation. Cost-effectiveness of the intervention will be determined, and we will plan for sustainability and national scale-up.

Findings

The trial commenced in April 2019 and is in the establishment phase. The trial builds on a body of work undertaken with key stakeholders defining the role of GPs in compensable injury, exploring their concerns and the development of evidence-based guidelines to address them.

Consequences

This project aims to change both practice and policy. Anticipated changes include:

• improvements in primary care through the implementation of an evidence-based clinical guideline that equips Australia’s GPs with real-world, evidence-based knowledge, resources and networks to enhance their confidence and improve their care

• improvements in patient health and return-to-work outcomes as a result of improved care received from GPs. In turn, we expect this will reduce health service utilization and promote retention in the workplace, thus reducing compensation claims

• sustainable change through co-creation and national scale up. This intervention will demonstrate how a health system, researchers and policy makers can work with GPs to facilitate the translation of research into clinical practice. Such an approach may be applied to the implementation of other high quality evidence in general practice. This engagement combined with a rigorous evaluation processes and measurable feasibility and economic value means that the intervention (if proven) can be nationally rolled out by compensation system partners.