Implementation of an augmented stepped mental health care service in Australian primary care: a mixed method study

Objective: StepCare is an online, stepped mental healthcare service in general practice which identifies adults with common mental disorders, recommends evidence-based treatments and monitors symptoms and risk, with feedback to the patient and GP. Previous data suggested that StepCare was acceptable and feasible, assisting GPs to identify and manage patients' depression and anxiety. Areas for improvement were recommended by GPs, practice staff and patients. StepCare was accordingly upgraded and a new implementation strategy was introduced, consistent with the Australian Government's reform agenda. This study aimed to evaluate the augmented StepCare and new implementation model. Methods: Two Primary Health Networks (PHNs) and 22 general practices took part. The StepCare team trained and supported PHN staff to implement the Service in their general practices. PHN staff, GPs, practice staff and patients rated the acceptability, feasibility and effectiveness of StepCare. New cases at screening and patients' symptom change over 12 weeks were measured. Implementation facilitators and barriers were also investigated. Results: The majority of PHN staff, GPs, practice staff and patients rated StepCare as acceptable and feasible, GPs reported it assisted their identification and management of common mental health conditions and most patients indicated they would recommend it to a friend. 37% of patients reporting symptoms at screening were new cases. Patients' depression symptoms reduced significantly by 12 weeks. Discussion: Augmented StepCare is able to identify new cases and produce clinical change within routine general practice. It also has the potential to be implemented by PHNs with assistance from the StepCare team.