Evaluation of an ongoing scale-up of a task shared, evidence-based package for integrating care for common mental disorders into primary health care in two under-resourced provinces in South Africa.

对正在扩大南非两个资源贫乏省份的任务共享、基于证据的一揽子计划的评估，该计划旨在将常见精神障碍的护理纳入初级卫生保健。

• 批准号: 10674226
• 负责人: Inge Petersen
• 金额: $ 7.94万
• 依托单位: UNIVERSITY OF KWAZULU-NATAL
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-04-26 至 2023-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10674226
• 关键词: Adherence; Adoption; Affect; African; Attitude; Caring; Chronic; Chronic Care; Chronic Disease; Client satisfaction; Clinic; Collaborations; Consolidated Framework for Implementation Research; Counseling; Country; Disease; Epidemic; Evaluation; Evidence based practice; Guidelines; HIV; Health; Health Personnel; Health Policy; Health care facility; Health system; Interview; Investments; Knowledge; Maintenance; Measures; Mental Depression; Mental Health; Mental Health Services; Mental disorders; Methods; Mozambique; Nurses; Observational Study; Outcome; Patient Care; Patient-Focused Outcomes; Persons; Pharmaceutical Preparations; Predictive Factor; Primary Health Care; Process; Professional counselor; Province; Quality of Care; Reach Effectiveness Adoption Implementation and Maintenance; Research; Resource-limited setting; Resources; Self Care; Services; South Africa; South African; System; Tanzania; Terminology; Testing; Training; Tuberculosis; Universities; Vaccines; Washington; care systems; clinical decision support; comorbidity; cost; evidence base; health care delivery; implementation framework; implementation outcomes; improved; informant; member; multiple chronic conditions; programs; satisfaction; scale up; screening; success; uptake

Many Southern African countries are confronted with the challenge of having to adapt their health systems to respond to a changing disease profile characterized by a rise in multiple chronic comorbidities. HIV, which is now considered a chronic condition, and tuberculosis are increasingly co-occurring with a rising burden of non-communicable diseases (NCDs). Included in this mix are Common Mental Disorders (CMDs), which interfere with adherence and self-care, compromising global investments in vaccines, medications and other treatments. The proposed scale-up study responds to the urgent need to generate knowledge of how best to scale up integrated evidence-based practices for CMDs into real- world primary health care (PHC) platforms for multiple chronic diseases in resource- constrained settings. Our proposed study will be layered onto the ongoing scale-up of our task-shared, evidence-based package for integrating care for CMDs into this integrated chronic care system in PHC facilities with the following specific aims: Aim 1: Utilize the RE- AIM framework to examine the reach, effectiveness, adoption, implementation and maintenance of scale-up in the two different real-world district contexts. Aim 1.1: Track RE- AIM outcomes in implementing facilities; Aim 1.2: Engage in continuous quality improvement at facility and district levels. We will examine indicators of mental health screening, referral, treatment uptake, adherence, quality of care; health care worker training, knowledge, attitudes and satisfaction; patient outcomes and satisfaction; cost impact; and organizational integration. Aim 2: Utilize the Consolidated Framework for Implementation Research (CFIR) framework to examine and adapt to multi-level factors that influence implementation in the two different real-world district contexts. Aim 2.1: Identify and assess multi-level factors affecting package implementation; Aim 2.2: Engage health system managers and planners at district, provincial and national levels in a participatory process to propose adaptations for continued efficient implementation. We will conduct key informant interviews in high-, medium- and low-performing clinics to identify multi-level factors and engage stakeholders in a participatory process.

许多南部非洲国家都面临着必须适应其的挑战 卫生系统应对不断变化的疾病特征，其特征是多重增加 慢性合并症。艾滋病毒现在被认为是一种慢性疾病，结核病 越来越多地与非传染性疾病（NCD）的负担增加。 这种组合中包括常见的精神疾病（CMD），会干扰依从性 以及自我保健，损害全球在疫苗，药物和其他方面的投资 治疗。拟议的规模研究对迫切需要产生的需求做出回应 了解如何最好地将CMD的综合基于证据的实践扩展到实地 用于资源多种慢性疾病的世界初级卫生保健（PHC）平台 - 受限的设置。我们提出的研究将分层为我们的持续规模 任务共享的，基于证据的软件包，用于将CMD的护理集成到此集成中 PHC设施中具有以下特定目的的慢性护理系统：目标1：利用重新 瞄准框架以检查覆盖范围，有效性，采用，实施和 在两个不同的现实区域环境中维护规模。 AIM 1.1：轨道重新 实施设施的目标；目标1.2：进行持续质量改进 在设施和地区级别。我们将研究心理健康筛查，推荐， 治疗吸收，依从性，护理质量；卫生保健工作者培训，知识， 态度和满足；患者的结果和满意度；成本影响；和组织 一体化。目标2：利用合并框架进行实施研究（CFIR） 框架检查并适应影响实施的多层次因素 两个不同的现实区域环境。 AIM 2.1：识别和评估多层次因素 影响包装实施； AIM 2.2：让卫生系统经理和计划者参与 在地区，省和国家一级的参与过程中，提议适应 持续有效的实施。我们将在高中进行关键的线人访谈 中和低表现的诊所，以识别多层因素并参与利益相关者参与 参与过程。