FEASIBILITY OF NURSE-LED ANTIDEPRESSANT MEDICATION MANAGEMENT OF DEPRESSION IN AN HIV CLINIC IN TANZANIA
FEASIBILITY OF NURSE-LED ANTIDEPRESSANT MEDICATION MANAGEMENT OF DEPRESSION IN AN HIV CLINIC IN TANZANIA
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DOI：
10.2190/pm.43.2.a
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发表时间：
2012-01-01
影响因子：
2
通讯作者：
Sikkema, Kathleen J.
中科院分区：
文献类型：
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作者：
Adams, Julie L.;Almond, Maria L. G.;Sikkema, Kathleen J.
目标：撒哈拉以南非洲是全世界艾滋病毒感染率最高的地区，抑郁症在感染者中非常普遍。抑郁症对艾滋病毒结果的负面影响突出了在这一人群中识别和治疗抑郁症的必要性。在资源较低的环境中这样做的一个模式涉及将抑郁症治疗任务转移到初级保健;然而，艾滋病毒感染者通常在平行的艾滋病毒专业环境中接受治疗。我们采用了一种模式的任务转移，基于测量的护理（MBC），艾滋病毒诊所设置和测试其可行性在坦桑尼亚。MBC包括在有意义的时间间隔内测量抑郁症状，并根据疾病的测量调整抗抑郁药物治疗。方法：在坦桑尼亚的一家艾滋病门诊诊所，20名成年人参加了研究，随后由一名护士护理经理在基线和每4周测量一次抑郁症状，持续12周。护理经理利用基于算法的决策支持工具，在每次访视时向参与者的HIV提供者推荐个性化的抗抑郁药物剂量。结果：保留率高，忠实的护理经理MBC协议是例外。处方者对抗抑郁药处方剂量建议的遵循率较低。还注意到抗抑郁药的供应有限。尽管有挑战，基线抑郁评分在12周内下降。结论：整体而言，基于算法的处方决策护理支持模式是可行的。未来的研究应解决药物供应和剂量的实施问题。进一步将任务转移给相对较多和技能较低的卫生工作者，如护士助理，值得研究。（Inn.医学精神病学杂志2012;43：105-117）
Objective: Sub-Saharan Africa has the highest HIV prevalence worldwide and depression is highly prevalent among those infected. The negative impact of depression on HIV outcomes highlights the need to identify and treat it in this population. A model for doing this in lower-resourced settings involves task-shifting depression treatment to primary care; however, HIV-infected individuals are often treated in a parallel HIV specialty setting. We adapted a model of task-shifting, measurement-based care (MBC), for an HIV clinic setting and tested its feasibility in Tanzania. MBC involves measuring depressive symptoms at meaningful intervals and adjusting antidepressant medication treatment based on the measure of illness. Method: Twenty adults presenting for care at an outpatient HIV clinic in Tanzania were enrolled and followed by a nurse care manager who measured depressive symptoms at baseline and every 4 weeks for 12 weeks. An algorithmbased decision-support tool was utilized by the care manager to recommend individualized antidepressant medication doses to participants' HIV providers at each visit. Results: Retention was high and fidelity of the care manager to the MBC protocol was exceptional. Follow through of antidepressant prescription dosing recommendations by the prescriber was low. Limited availability of antidepressants was also noted. Despite challenges, baseline depression scores decreased over the 12-week period. Conclusions: Overall, the model of algorithm-based nursing support of prescription decisions was feasible. Future studies should address implementation issues of medication supply and dosing. Further task-shifting to relatively more abundant and lower-skilled health workers, such as nurses' aides, warrants examination. (Inn. J. Psychiatty in Medicine 2012;43:105-117)