Implementing work-related Mental health guidelines in general PRacticE (IMPRovE): A trial evaluating the impact of a complex intervention involving a digital Community of Practice and academic detailing on guideline adherence

INTERVENTION: The intervention will comprise academic detailing (AD) specifically for study, participation in a digital community of practice (CoP) specifically for study, and provision of resources which are readily available. The CoP is an online portal designed to benefit GPs’ delivery of treatment to patients who present with work‐related mental health problems. As an online community equipped with learning resources and facilitated by Monash University personnel, the CoP will be created as a purpose‐designed platform of information sharing, exchange, and practitioner engagement. Academic Detailing We will appoint GPs who currently provide independent advice to compensation scheme regulators as Academic Detailers and provide them with training on the Clinical Guideline for the Diagnosis and Management of Work‐related Mental Health Conditions in General Practice (the Guideline). Each GP cluster (GP clinic) will be detailed on how to improve care for patients with work‐related mental health conditions in accordance with the Guideline. This will include receiving a suite of resources such as the Guideline recommendations and resources supplied by the partners. Academic detailers will also invite GP participation in a digital CoP and enrol them as members to this community. Delivering the face‐to‐face AD session will be GPs who are also seen to be Clinical Opinion Leaders, highly respected amongst their peers and well‐versed in the complexities around the workers’ compensation system. Each of the participation GP will attend one academic session in their GP practice (locations of rural, remote and urban clinics across both NSW and Victoria) before they are enrolled on the CoP. The Academic Detailing (AD) Session will follow a set structure bu CONDITION: Depression (in direct or indirect association with workplace factors);Anxiety (in direct or indirect association with workplace factors);Adjustment Disorder (in direct or indirect association with workplace factors);Post Traumatic Stress Disorder (in direct or indirect association with workplace factors);Substance Misuse (in direct or indirect association with workplace factors);Acute Stress Disorder (in direct or indirect association with workplace factors); ; Depression (in direct or indirect association with workplace factors) ; Anxiety (in direct or indirect association with workplace factors) ; Adjustment Disorder (in direct or indirect association with workplace factors) ; Post Traumatic Stress Disorder (in direct or indirect association with workplace factors) ; Substance Misuse (in direct or indirect association with workplace factors) ; Acute Stress Disorder (in direct or indirect association with workplace factors) Mental Health ‐ Addiction Mental Health ‐ Anxiety Mental Health ‐ Depression Public Health ‐ Health service research PRIMARY OUTCOME: The primary outcome is adherence to guideline‐based care by participating GPs using virtual simulated patient scenarios (VSPSs). The VSPSs, each approximately 15 minutes duration, will be focused on typical presentations by patients presenting to GPs with work‐related mental health conditions and require GPs to assess, diagnose and manage patients as they would in their own consulting room. They will present GPs with a range of scenarios with varying levels of complexity and patient circumstance. We will assess the change in adherence score between GPs in Step 1 and Step 2. [We will assess the primary outcome at baseline and 18 months post‐trial commencement.] ; ; • Health service utilization survey designed specifically for this study (via MBS and PBS data and claims databases, and a health utilization survey with patients). ; • Additional costs (savings) and health gains within the trial‐period associated with the intervention as compared to the control phase. SECONDARY OUTCOME: Changes in patient psychological symptoms (using the DASS‐21) will be measured using a patient survey. We will assess the change in patient psychological symptoms between patients whose GPs are in the intervention group and patients whose GPs are in the control group. ; [Patients will answered surveys at baseline and every six months following their initial GP consultation, until the end of the intervention period (i.e., 18 moths after commencement). Anticipated date of last data collection (for patient‐participants) should occur no later than 18 months after the anticipated date of last GP‐participant enrolment. ] Changes in patient psychological symptoms (using the SF‐36 version 2.0) will be measured using patient surveys. We will assess the change in patient psychological symptoms between patients whose GPs are in the intervention group and patients whose GPs are in the control group.[Patients will answer surveys at baseline and every six months following their initial GP consultation, until the end of the intervention period (i.e., 18 months after commencement). Anticipated date of last data collection (for patient‐participants) should occur no later than 18 months after the anticipated date of last GP‐participant enrolment.] Health economic evaluation using: ; [Health economic data will be gathered throughout the trial using: ; • MBS and PBS data and claims databases. ; • Additional costs (savings) and health gains within the trial‐period ; ; A Health utilization survey will be completed by patients at baseline and every six months following their initial GP consultation, until the end of the intervention period (i.e., 18 moths after commencement).] Process evaluation using the Realist Evaluation model involving quantitative and qualitative methods to understand “what worked for whom in what circumstances”. This evaluative framework examines context, mechanism, and outcomes and will consist of: ; a) GPs completing a pre, post and longitudinal trial knowledge, attitudes, and practices (KAP) survey to identify changes that occurred and barriers and facilitators to the intervention and implementing the Guideline in practice; ; b) post‐trial semi‐structured phone interviews with 20 GPs to assess their perceptions of the research and intervention process and the impact on their practice, and identification of factors to assist in scale up; ; c) post‐trial semi‐structured phone interviews with 20 patients to assess their perceptions of the research and the impact of the intervention on the care they received; ; d) meeting notes review or post‐trial semi‐structured phone interviews with members of the Intervention Advisory Group and GP Reference Group to assess their perceptions of the research and the potential ongoing sustainability of delivering the digital CoP; and ; e) The quality of engagement with the CoP and strength of relationships built through participation in the CoP will be examined using networking analysis. ; [Process evaluation data will be gathered throughout the trial : ; a) GPs completing a KAP survey at baseline, and 18 months post trial commencement; ; b) post‐trial semi‐structured phone interviews with 20 GPs at the end of the trial; ; c) post‐trial semi‐structured phone interviews with 20 patients at the end of the trial; ; d) meeting notes review or semi‐structured phone interviews with members of the* Intervention Advisory Group and GP Reference Group at the end of the trial. ; e) Web analytics will be collected from commencement of the trial until the end of the trial. ; ] Return to work outcomes (using relevant measures of the National Return‐To‐Work Survey) will be measured using patient surveys. We will assess the change in work engagement between patients in the intervention group and the control group.[Patients will answer surveys at baseline and every six months following their initial GP consultation, until the end of the intervention (i.e., 18 moths after commencement). ] INCLUSION CRITERIA: GPs: high caseload GPs (i.e., are listed within the top 25th percentile of caseload on the SIRA (NSW), WorkSafeVictoria and/or Comcare databases (of GPs based in NSW and Vic only). Patients: >18 years old, who are employed at the time of enrolment and who have a confirmed or suspected work‐related mental health condition. Patient participants may display symptoms of a primary mental health condition (i.e. those with a direct association between stressor(s) and symptom(s)) or a secondary mental health condition (i.e. those with an in‐direct association between stressor(s) and symptom(s) such as depression following a musculoskeletal work‐related injury).