College of Medicine and Public Health, Flinders University, GPO Box 2100, Adelaide, SA, 5001, Australia.
Lived Experience Australia, PO Box 96, 5048, Brighton, Australia.
Trials. 2024 May 14;25(1):319. doi: 10.1186/s13063-024-08165-y.
The demand for mental health services in Australia is substantial and has grown beyond the capacity of the current workforce. As a result, it is currently difficult for many to access secondary healthcare providers. Within the secondary healthcare sector, however, peer workers who have lived experience of managing mental health conditions have been increasingly employed to intentionally use their journey of recovery in supporting others living with mental health conditions and their communities. Currently, the presence of peer workers in primary care has been limited, despite the potential benefits of providing supports in conjunction with GPs and secondary healthcare providers.
This stepped-wedge cluster randomised controlled trial (RCT) aims to evaluate a lived experience peer support intervention for accessing mental health care in primary care (PS-PC). Four medical practices across Australia will be randomly allocated to switch from control to intervention, until all practices are delivering the PS-PC intervention. The study will enrol 66 patients at each practice (total sample size of 264). Over a period of 3-4 months, 12 h of practical and emotional support provided by lived experience peer workers will be available to participants. Scale-based questionnaires will inform intervention efficacy in terms of mental health outcomes (e.g., self-efficacy) and other health outcomes (e.g., healthcare-related costs) over four time points. Other perspectives will be explored through scales completed by approximately 150 family members or carers (carer burden) and 16 peer workers (self-efficacy) pre- and post-intervention, and 20 medical practice staff members (attitudes toward peer workers) at the end of each study site's involvement in the intervention. Interviews (n = 60) and six focus groups held toward the end of each study site's involvement will further explore the views of participants, family members or carers, peer workers, and practice staff to better understand the efficacy and acceptability of the intervention.
This mixed-methods, multi-centre, stepped-wedge controlled study will be the first to evaluate the implementation of peer workers in the primary care mental health care sector.
Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12623001189617. Registered on 17 November 2023, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=386715.
澳大利亚对心理健康服务的需求很大，并且已经超出了当前劳动力的承受能力。因此，许多人现在很难获得二级医疗保健提供者的服务。然而，在二级医疗保健领域，具有管理心理健康状况经验的同行工作者越来越多地被雇佣，以有意利用他们的康复之旅来支持其他患有心理健康状况的人和他们的社区。目前，尽管在与全科医生和二级医疗保健提供者一起提供支持方面具有潜在益处，但同行工作者在初级保健中的存在仍然有限。
这项阶梯式楔形集群随机对照试验（RCT）旨在评估初级保健中同行支持干预措施对获得心理健康护理的影响（PS-PC）。澳大利亚的四家医疗实践将被随机分配从对照组切换到干预组，直到所有实践都提供 PS-PC 干预。每个实践将招募 66 名患者（总样本量为 264 名）。在 3-4 个月的时间内，同行工作者将提供 12 小时的实际和情感支持。量表问卷将在四个时间点上报告干预对心理健康结果（例如自我效能感）和其他健康结果（例如医疗保健相关成本）的疗效。通过大约 150 名家庭成员或照顾者（照顾者负担）和 16 名同行工作者（自我效能感）在干预前后完成的量表，以及每个研究地点结束时的 20 名医疗实践工作人员（对同行工作者的态度），将从其他角度探讨干预的疗效。访谈（n=60）和六个焦点小组将在每个研究地点参与结束时举行，以进一步探讨参与者、家庭成员或照顾者、同行工作者和实践工作人员的观点，以更好地了解干预的疗效和可接受性。
这项混合方法、多中心、阶梯式楔形对照研究将是第一个评估同行工作者在初级保健心理健康保健部门实施情况的研究。
澳大利亚新西兰临床试验注册中心（ANZCTR）ACTRN12623001189617。于 2023 年 11 月 17 日注册，https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=386715。
