Depression care integration in tuberculosis services: A feasibility assessment in Pakistan
Depression care integration in tuberculosis services: A feasibility assessment in Pakistan
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DOI：
10.1111/hex.13985
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发表时间：
2024-02-01
影响因子：
3.2
通讯作者：
Siddiqi，Najma
中科院分区：
文献类型：
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作者：
Afaq，Saima;Ayub，Aliya;Siddiqi，Najma
背景结核病 (TB) 患者中抑郁症的并发是一个关键问题，导致治疗结果不佳、住院时间延长和医疗费用增加。目的本研究的目的是评估在巴基斯坦结核病服务中提供共同设计的抑郁症护理途径的可行性。设计混合方法研究。设置和参与者在巴基斯坦白沙瓦的三个结核病机构（包括初级、二级和三级护理机构）对结核病患者进行常规抑郁症筛查。采用连续抽样技术，将 2021 年 11 月至 2022 年 2 月期间在三个结核病治疗机构就诊的所有 18 岁或以上患者（男性和女性）纳入研究。 结果 在过去 4 周内，共有 301 名确诊结核病患者到访过三个结核病治疗机构； 191/301 名患者接受了抑郁症筛查。 191 名结核病患者中，约 35% 的抑郁症筛查呈阳性，且严重程度各异。定性研究结果强调了综合抑郁症护理的可接受性，强调开放沟通和同理心态度的重要性。整合的障碍包括耻辱、后勤挑战、患者不依从和成本负担。促进因素包括医疗保健提供者的同理心态度以及同一机构内心理健康服务的可用性。 结论 结核病患者的抑郁负担很高，凸显了该人群迫切需要心理健康支持。综合护理的可接受性是显而易见的，其中诸如同一地点的心理健康服务、培训医疗保健提供者和提供者的同理心态度等因素发挥着至关重要的作用。需要进一步研究来评估综合结核抑郁症筛查系统在改善健康结果、实施、可扩展性以及对更广泛的医疗保健系统的影响方面的有效性。患者和公众的贡献为了创建更具包容性和全面的结核病和抑郁症护理途径，我们收集了服务提供者和服务使用者（结核病患者及其护理人员）的意见。在途径交付期间，我们还与社区领袖、社会活动家和来自不同部门的卫生专业人员举行了反思会议，以获取他们的见解。通过鼓励不同性别和年龄组的患者和护理人员参与，解决了权力、性别和年龄不平衡问题。这种方法确保在制定护理途径时考虑所有利益相关者的观点。
BackgroundThe co‐occurrence of depression among tuberculosis (TB) patients is a critical issue, contributing to poor treatment outcomes, prolonged hospitalisations and increased healthcare expenses.ObjectiveThe objective of this study was to assess the feasibility of delivering a co‐designed depression care pathway within TB services in Pakistan.DesignMixed‐method study.Setting and ParticipantsRoutine depression screening for TB patients was conducted at three TB facilities in Peshawar, Pakistan, encompassing primary, secondary and tertiary care settings. All patients aged 18 or above (male and female) attending the three TB facilities between November 2021 and February 2022 were included in the study using the consecutive sampling technique.ResultsA total of 301 people with confirmed TB, within the past 4 weeks, visited the three TB care facilities; 191/301 patients were screened for depression. Approximately 35% of the 191 TB patients screened positive for depression, with varying severity levels. Qualitative findings highlighted the acceptability of integrated depression care, emphasising the importance of open communication and empathetic attitudes. Barriers to integration include stigma, logistical challenges, patient noncompliance and cost burdens. Facilitators included the empathetic attitude of healthcare providers and the availability of mental health services within the same facility.ConclusionThere is a high burden of depression in patients with TB, highlighting the pressing need for mental health support in this population. Acceptability of integrated care was evident, with factors such as co‐located mental health services, training healthcare providers and provider empathetic attitudes playing a crucial role. Further research is required to evaluate the effectiveness of the integrated TB‐depression screening systems towards improved health outcomes, implementation, scalability and impact on the broader healthcare system.Patient and Public ContributionTo create a more inclusive and comprehensive TB and depression care pathway, we gathered input from both service providers and service users (TB patients, their carers). Reflective meetings with community leaders, social activists and health professionals from various sectors were also conducted during pathway delivery to get their insights. Power, gender and age imbalances were addressed by encouraging participation of patients and carers across gender and age groups. This approach ensured that the perspectives of all stakeholders were considered in the development of the care pathway.