Developing a tailored implementation plan for collaborative care of perinatal depression care in community health centers in Vietnam

制定越南社区卫生中心围产期抑郁症护理协作护理定制实施计划

基本信息

批准号：
10001618
负责人：
IAN Moore BENNETT
金额：
$ 16.08万
依托单位：
UNIVERSITY OF WASHINGTON
依托单位国家：
美国
项目类别：
财政年份：
2019
资助国家：
美国
起止时间：
2019-09-01 至 2022-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10001618
关键词：
Address Adult Affect Antidepressive Agents Award Awareness Caring Child Child Care Chronic Care Chronic Disease Cities Clinical Country Development Discipline of obstetrics Disease Drops Effectiveness Elements Evidence based treatment Faculty Feedback Growth Gynecologic Health Health Personnel Health Services Health system Healthcare Systems Heritability Hospitals Hybrids Impairment Infant Infrastructure Intervention Journals Learning Link Maternal Mortality Medical Medicine Mental Depression Mental Health Mental disorders Methods Modeling Neighborhood Health Center Outcome Outcome Measure Patients Perinatal Perinatal Care Persons Pharmaceutical Preparations Pharmacy facility Postpartum Period Pregnancy Prenatal care Primary Health Care Process Program Development Provider Public Health Publications Quality of Care Randomized Research Research Personnel Research Training Resources Risk Rivers Rural Self Care Service delivery model Service setting Source Structure Suicide Suicide prevention Training Training Programs United States National Institutes of Health Universities Vietnam Washington Woman Work World Health Organization base behavioral health care delivery care systems collaborative care community based participatory research community setting cost disability effective therapy effectiveness trial efficacy trial evidence base flexibility food insecurity health care delivery health information technology implementation research implementation science implementation strategy improved improved outcome individualized medicine innovation low and middle-income countries medical specialties meetings mental health organization novel peripartum depression pregnancy disorder programs prospective psychosocial research to practice screening service delivery skills social stigma suicidal risk tool voltage

项目摘要

Project Summary/Abstract Perinatal depression is a common and serious disorder, with suicide representing a major cause of maternal mortality, but few women from low and middle income countries (LMICs) receive effective treatment. Effective models of care that improve perinatal depression and support suicide prevention exist but have not yet been widely implemented in routine maternal-child care services in LMICs. These models include innovations to allow scarce specialty care to support high quality care in community settings and so are potentially well suited to low resourced countries. A major obstacle to achieving the benefits of these models is a lack of appropriate adaptation to the cultural and health services context of the settings in which they will be delivered. While evidence based models may work in the context in which they were developed maintaining too great an allegiance to fidelity without allowing adaptation can result in reduced effectiveness or “voltage drop” in new settings. In contrast, a focus on flexible adaptation of care approaches has the potential to achieve or even exceed the outcomes seen in controlled efficacy trials by supporting intervention “reinvention” within the context of a learning health system. Implementation strategies, in addition to the elements of the health service delivery itself, must also be appropriate to the cultural and health services context in which care innovations are to be introduced. We plan to use a participatory approach to systematically identify and adapt key elements of evidence based models of perinatal depression care delivery to the cultural and health services context of Can Tho, Vietnam. This federal-provincial city provides health services to a large region of the Mekong River Delta with over 19 million, mostly rural inhabitants. Over the two-year study period we will first develop a model, adapted from evidence based approaches, for screening and treatment for women receiving perinatal care in community health centers as well as obstetric hospitals. Simultaneous exploration of potential implementation strategies to support and sustain this model in context will be identified along with the creation of a training and implementation toolkit for this setting. Using these strategies and tools we will then carry out a pilot perinatal collaborative care study in a public health center and the prenatal care practice of the Can Tho Obstetric and Gynecologic Hospital. The results of this pilot will be used to revise and enhance the treatment model and related implementation tools. These will be used in subsequent trials of effectiveness and/or implementation broadly in the health care system of Can Tho.

项目概要/摘要围产期抑郁症是一种常见且严重的疾病，自杀是孕产妇抑郁症的主要原因死亡率，但低收入和中等收入国家 (LMIC) 的妇女很少能得到有效的治疗。改善围产期抑郁症和支持自杀预防的护理模式已经存在，但尚未得到落实这些模式在中低收入国家的日常母婴护理服务中得到广泛实施。允许稀缺的专业护理支持社区环境中的高质量护理，因此可能非常适合对于资源匮乏的国家来说，实现这些模式的好处的一个主要障碍是缺乏适当的方法。适应其提供环境的文化和卫生服务背景。基于证据的模型可能在其开发的背景下发挥作用，但保持了太大的忠于保真度而不允许适应可能会导致新产品的有效性降低或“电压下降” 相比之下，注重护理方法的灵活调整有可能实现甚至实现目标。通过支持干预措施“重塑”，超越了对照功效试验中看到的结果除了卫生服务的要素之外，还包括学习卫生系统的实施策略。服务本身也必须适合护理创新的文化和卫生服务背景我们计划采用参与式方法来系统地确定和调整关键要素。在文化和卫生服务背景下提供基于证据的围产期抑郁症护理模式越南芹苴这座联邦省级城市为湄公河的大片地区提供医疗服务。三角洲人口超过 1900 万，其中大部分是农村居民。在两年的研究期间，我们将首先开发一个改编自基于证据的方法的模型，用于对接受围产期治疗的妇女进行筛查和治疗同时探索社区卫生中心和产科医院的护理潜力。将在创建时确定支持和维持该模式的实施策略然后，我们将使用这些策略和工具来执行此设置的培训和工具包。公共卫生中心围产期协作护理试点研究和芹苴市的产前护理实践该试点的结果将用于修改和加强妇产科医院的治疗。这些将用于后续有效性和/或测试的模型和实施相关工具。在芹苴的医疗保健系统中广泛实施。