Increasing Uptake of Depression Screening and Treatment Guidelines in Cardiac Patients: A Behavioral and Implementation Science Approach to Developing a Theory-Informed, Multilevel Implementation Strategy.
Increasing Uptake of Depression Screening and Treatment Guidelines in Cardiac Patients: A Behavioral and Implementation Science Approach to Developing a Theory-Informed, Multilevel Implementation Strategy.
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DOI：
10.1161/circoutcomes.122.009338
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发表时间：
2022-11
影响因子：
6.9
通讯作者：
Moise, Nathalie
中科院分区：
文献类型：
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作者：
Reuter, Katja;Genao, Kirali;Callanan, Emily M.;Cannone, Diane E.;Giardina, Elsa-Grace;Rollman, Bruce L.;Singer, Jessica;Slutzky, Amy R.;Ye, Siqin;Duran, Andrea T.;Moise, Nathalie
抑郁症导致冠心病（CHD）患者的健康状况不佳。尽管指南建议对抑郁型冠心病患者进行筛查和治疗，但很少有患者得到最佳护理。我们运用行为科学和实施科学的方法来(i)确定冠心病患者抑郁症筛查和治疗的可概括的、多层次的障碍；（ii）制定一个有理论依据的、多层次的实施策略，以促进指南的采用。我们对冠心病患者抑郁症筛查和治疗的障碍（即药物、运动、心脏康复和/或治疗）进行了叙述性回顾，包括来自748名研究参与者的数据。根据行为改变车轮框架和实施变革的专家建议（ERIC），我们定义了多层次的目标行为，特征决定因素（能力，机会，动机），并绘制了可行，可接受和公平的干预功能和行为改变技术的障碍，以制定针对医疗保健系统/提供者和患者的多层次实施策略。我们确定了系统/提供者级别（例如，能力：知识；机会：工作流集成；动机：所有权）和患者级别（例如，能力：知识；机会：移动性；动机：症状否认）的实施障碍。可接受的、可行的和公平的干预功能包括教育、说服、环境重组和使能。ERIC策略包括学习协作、审核、反馈和教育材料。促进抑郁症筛查/治疗的最终多组分策略（iHeart DepCare）包括与诊所工作人员举行解决问题的会议（系统）；教育/激励视频、电子健康记录提醒/决策支持（提供者）；共享决策（eSDM）工具，为患者提供多种功能，例如患者激活，患者治疗选择支持。我们应用实施和行为科学方法来确定实施障碍，并制定一个多层次的实施策略，以增加冠心病患者抑郁症筛查和治疗的吸收。多层次实施策略将在未来的混合II有效性-实施试验中进行评估。
Depression leads to poor health outcomes in coronary heart disease (CHD) patients. Despite guidelines recommending screening and treatment of depressed CHD patients, few patients receive optimal care. We applied behavioral and implementation science methods to (i) identify generalizable, multi-level barriers to depression screening and treatment in CHD patients and (ii) develop a theory-informed, multi-level implementation strategy for promoting guideline adoption. We conducted a narrative review of barriers to depression screening and treatment in CHD patients (i.e., medications, exercise, cardiac rehabilitation, and/or therapy) comprising data from 748 study participants. Informed by the Behaviour Change Wheel framework and Expert Recommendations for Implementing Change (ERIC), we defined multi-level target behaviors, characterized determinants (capability, opportunity, motivation), and mapped barriers to feasible, acceptable, and equitable intervention functions and behavior change techniques to develop a multi-level implementation strategy, targeting healthcare systems/providers and patients. We identified implementation barriers at the system/provider level (e.g., Capability: knowledge; Opportunity: workflow integration; Motivation: ownership) and patient level (e.g., Capability: knowledge; Opportunity: mobility; Motivation: symptom denial). Acceptable, feasible, and equitable intervention functions included education, persuasion, environmental restructuring, and enablement. ERIC strategies included learning collaborative, audit, feedback, and educational materials. The final multi-component strategy (iHeart DepCare) for promoting depression screening/treatment included problem-solving meetings with clinic staff (system); educational/motivational videos, electronic health record reminders/decisional support (provider); and a shared decision-making (eSDM) tool with several functions for patients, e.g., patient activation, patient treatment selection support. We applied implementation and behavioral science methods to identify implementation barriers and to develop a multi-level implementation strategy for increasing uptake of depression screening and treatment in CHD patients as a use case. The multi-level implementation strategy will be evaluated in a future hybrid II effectiveness-implementation trial.