通过南非的RE-AIM框架在日常初级医疗保健中加强综合抑郁服务
Inge Petersen1,2, Christopher G Kemp3, Deepa Rao4
1Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa.
PLOS global public health
|November 13, 2023
概括
在南非,将心理健康纳入初级卫生保健 (PHC) 改善了抑郁症护理转诊. 加强实施战略提高了诊断和转诊率,但治疗普及仍然是一个挑战.
科学领域:
- 公共卫生 公共卫生
- 心理健康服务研究 心理健康服务研究
- 实施科学 实施科学
背景情况:
- 将心理健康纳入初级卫生保健 (PHC) 对于改善健康结果和减少低收入和中等收入国家心理健康治疗差距至关重要.
- 在常规PHC环境中实施基于证据的心理健康模型面临重大挑战.
- 南非的资源稀缺环境为研究这种整合提供了关键的背景.
研究的目的:
- 确定有效的实施策略,以证据为基础的抑郁症护理模式,整合到南非的常规PHC服务中.
- 通过准实验性设计,评估和比较初始策略包和加强策略包之间的实施结果.
主要方法:
- 采用了一种代的,准实验性的,观察性的实施研究设计,以 RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) 框架为指导.
- 评估了两个实施阶段:第一阶段在10个PHC诊所,第二阶段 (加强套餐) 在南非KwaZulu-Natal的19个PHC诊所.
- 数据分析的重点是比较两个阶段之间的转诊率,诊断率和治疗采用率.
主要成果:
- 强化实施方案显著增加了被转介服务用户接受咨询治疗的可能性 (OR 23.15,p < .001).
- 培训和使用经过验证的心理健康查工具,加上支持,促进了护士级诊断率 (OR 3.75,p = 0.02).
- 临床辅导员的持续可用性与更高的转诊概率相关 (OR 5.9,p = 0.022),而不一致的服务阻碍了治疗的开始.
结论:
- 加强实施策略,包括经过验证的查工具和一致的辅导员可用性,显著改善了PHC内的抑郁症护理级联结果.
- 实施研究对于完善策略至关重要,以有效地将心理健康服务纳入常规初级保健中.
- 应对治疗采用挑战需要进一步调查和定制干预措施在综合护理模式.
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