Quality measures for primary mental healthcare: a multistakeholder, multijurisdictional Canadian consensus

To develop quality measures using a consensus-based, multistakeholder process to improve delivery of mental health services within primary healthcare settings.

A three-stage consensus model culminating in a two-round, modified Delphi postal survey ranking quality measures according to 'actionability,' relevance and overall importance.

More than 800 people from all 10 provinces and three territories in Canada participated in the study, representing consumers/advocates, clinicians, academics and government decision-makers from regional, provincial and federal levels. A small group with expertise in First Nations and rural-setting health issues was also included, as well as international experts.

The top overall pan-Canadian measure was 'Education about Depression.' 'Actionability' was a key criterion for many of the top 30 measures. Fifty per cent of these measures focused on three major themes: depression, self-harm and access to a broader spectrum of treatment (such as outreach services and psychotherapy). Additional themes included the need for greater collaboration, respectful treatment of patients and families, and improved evaluation of patients. One-way ANOVA results indicated statistically significant differences (p <0.05) between academics, clinicians, consumers and decision-makers on approximately 5% of quality measure ratings. The majority (85% of the 5%) of these differences involved consumer stakeholders.

A small set of specific consensus measures were identified through a rigorous, evidence-informed process. These measures can be used for system-wide changes or at the individual practice level. Although these measures have been developed within a Canadian context, the methodology utilised and the measures selected can be adapted elsewhere.