ESSENCE (Enabling translation of Science to Service to ENhance Depression CarE) Scale-Up

ESSENCE（将科学转化为服务，以增强抑郁症 CarE）规模化

• 批准号: 10883855
• 负责人: Vikram H Patel
• 金额: $ 19.48万
• 依托单位: HARVARD MEDICAL SCHOOL
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-07-01 至 2024-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10883855
• 关键词: Accreditation; Address; Antidepressive Agents; Behavioral; Caring; Clinical Treatment; Community Health Aides; Competence; Cost Analysis; Country; Development; Educational Intervention; Effectiveness; Evidence based treatment; Funding; Future; Goals; Government; Health; Health care facility; Health system; Healthcare Systems; High Prevalence; Human Resources; Income; India; Information Systems; Intervention; Knowledge; Mental Depression; Mental Health; Mental Health Services; Mission; Modeling; Outcome; Patients; Persons; Pharmaceutical Preparations; Population; Primary Care; Primary Health Care; Public Health; Randomized, Controlled Trials; Research; Resource-limited setting; Science; Services; Training; Translational Research; burden of illness; care delivery; cost effective; cost effectiveness; disability-adjusted life years; effectiveness evaluation; evidence base; implementation intervention; improved outcome; innovation; mental health policy; programs; psychologic; rural area; scale up; service gap; social; supply chain; technology platform; treatment strategy

PROJECT ABSTRACT (SCALE UP COMPONENT) Depression is the leading mental health cause of the Global Burden of Disease and accounts for 37% of the mental health related Disability Adjusted Life Years (DALYs) in India. However, despite the knowledge of evidence-based clinical treatments and delivery models, treatment gaps exceed 90% in rural areas. In order to address this science to service gap, our aim is to generate knowledge on the most effective and cost-effective approaches to sustainably scale up the ESSENCE `package' (collaborative stepped care delivery of two evidence-based clinical treatments for moderate to severe depression in primary care attenders) to four districts (population of approximately 5.3 million) in the state of Madhya Pradesh with delivery entirely carried out by existing health workers funded by the government. ESSENCE consists of two complementary, sequential randomized control trials, conducted over five years to address following specific aims: a) the development and evaluation of the effectiveness and cost- effectiveness of On-Line Training (OLT) interventions (with and without guidance) compared with Face- to-Face (F2F) training on the competence of Accredited Social Health Activists (ASHA workers), community health workers deployed in India's National Health Mission, to deliver the Healthy Activity Program (HAP), an evidence-based brief psychological treatment for depression in primary care attenders; and b) the development and evaluation of the effectiveness and cost-effectiveness of two levels of implementation support interventions to address the key barriers to the collaborative stepped care delivery of evidence-based clinical treatments for depression (the HAP and antidepressant medication) compared with the current strategy of training alone, on outcomes in patients with moderate to severe depression in primary care. ESSENCE builds on a substantial body of evidence in the study country, led by the program PIs, to capitalize on the unique and timely opportunity offered by the strong engagement of our research program with the Ministry of Health, Government of Madhya Pradesh to address the critical knowledge gaps regarding the training and implementation support strategies necessary to scale-up evidence-based treatments for depression in a low resource setting. The most innovative aspect of research is the use of technology platforms for delivery of both the training and implementation support interventions to enhance the likelihood of future scaling up of these interventions. The knowledge gained will be the first from any low or middle income country for such training and implementation interventions and could thus be instrumental in influencing the mental health policy agenda beyond the study country.

项目摘要（扩展组件） 抑郁症是全球疾病负担的首要心理健康原因，占全球疾病负担的 37% 印度与心理健康相关的残疾调整生命年（DALY）。然而，尽管 对循证临床治疗和实施模式的了解，农村地区的治疗差距超过 90% 地区。为了解决科学与服务之间的差距，我们的目标是生成有关最重要领域的知识 持续扩大 ESSENCE“一揽子计划”（协作 对中度至重度抑郁症进行两种循证临床治疗的阶梯式护理 初级保健服务人员）到中央州的四个地区（人口约 530 万） 该邦的分娩完全由政府资助的现有卫生工作者进行。 ESSENCE 包含两项互补的、连续的随机对照试验，进行了五次以上 年实现以下具体目标：a）制定和评估有效性和成本- 在线培训 (OLT) 干预措施（有指导和无指导）与 Face- 相比的有效性 关于经认可的社会健康活动家（ASHA 工作人员）能力的面对面 (F2F) 培训， 部署在印度国家卫生使命中的社区卫生工作者，以开展健康活动 计划 (HAP)，一种针对初级保健中抑郁症的循证简短心理治疗 出席者； b) 两个层面的有效性和成本效益的制定和评估 实施支持干预措施，以解决协作阶梯式护理的主要障碍 提供基于证据的抑郁症临床治疗（HAP 和抗抑郁药物） 与目前单独训练的策略相比，对中度至重度患者的结果 初级保健中的抑郁症。 ESSENCE 建立在研究国家的大量证据之上，由项目 PI 牵头， 利用我们研究计划的大力参与所提供的独特而及时的机会 与中央邦卫生部合作解决关键的知识差距 关于扩大基于证据的必要培训和实施支持战略 在资源匮乏的环境中治疗抑郁症。研究中最具创新性的方面是使用 提供培训和实施支持干预措施的技术平台 提高未来扩大这些干预措施的可能性。获得的知识将是第一位的 来自任何低收入或中等收入国家的此类培训和实施干预措施，并且可以 从而有助于影响研究国家以外的精神卫生政策议程。