Evaluation of a mental health training intervention for multidisciplinary teams in primary care in Brazil: a pre- and posttest study

Objectives: the aim of this research was to investigate whether a training intervention to enhance collaboration between mental health and primary care professionals improved the detection and management of mental health problems in primary health care in four large cities in Brazil. the training intervention was a multifaceted program over 96 h focused on development of a shared care model.Method: A quasiexperimental study design was undertaken with assessment of performance by nurse and general practitioners (GPs) pre- and postintervention. Rates of recognition of mental health disorders (compared with the General Health Questionnaire) were the primary outcome, while self-reports of patient-centered care, psychosocial interventions and referral were the secondary outcomes.Results: Six to 8 months postintervention, no changes were observed in terms of rate of recognition across the entire sample. Nurses significantly increased their recognition rates (from 23% to 39%, P=.05), while GPs demonstrated a significant decrease (from 42% to 30%, P=.04). There were significant increases in reports of patient-centered care, but no changes in other secondary outcomes.Conclusions: Training professionals in a shared care model was not associated with consistent improvements in the recognition or management of mental health problems. Although instabilities in the local context may have contributed to the lack of effects, wider changes in the system of care may be required to augment training and encourage reliable changes in behavior, and more specific educating models are necessary. (C) 2013 Elsevier Inc. All rights reserved.Universidade Federal de São Paulo, BR-04021070 São Paulo, BrazilUniv Estado Rio de Janeiro, Rio de Janeiro, BrazilFundacao Oswaldo Cruz, Escola Nacl Saude Publ, Rio de Janeiro, BrazilUniv Fed Ceara, Fortaleza, Ceara, BrazilUniv Manchester, NIHR Sch Primary Care Res, Manchester Acad Hlth Sci Ctr, Manchester M13 9PL, Lancs, EnglandUniversidade Federal de São Paulo, Dept Psychiat, BR-04021070 São Paulo, BrazilKings Coll London, Ctr Publ Mental Hlth, Hlth Serv & Populat Res Dept, Inst Psychiat, London WC2R 2LS, EnglandUniv Manchester, Hlth Serv Res, NIHR Sch Primary Care Res, Manchester Acad Hlth Sci Ctr, Manchester M13 9PL, Lancs, EnglandUniversidade Federal de São Paulo, BR-04021070 São Paulo, BrazilUniversidade Federal de São Paulo, Dept Psychiat, BR-04021070 São Paulo, BrazilWeb of Scienc