Facilitators, barriers and potential solutions to the integration of depression and non-communicable diseases (NCDs) care in Malawi: a qualitative study with service providers.
Facilitators, barriers and potential solutions to the integration of depression and non-communicable diseases (NCDs) care in Malawi: a qualitative study with service providers.
复制标题
DOI：
10.1186/s13033-021-00480-0
复制
发表时间：
2021-06-11
影响因子：
3.6
通讯作者：
Pence BW
中科院分区：
文献类型：
--
作者：
Zimba CC;Akiba CF;Matewere M;Thom A;Udedi M;Masiye JK;Kulisewa K;Go VF;Hosseinipour MC;Gaynes BN;Pence BW
在撒哈拉以南非洲地区，将抑郁症服务纳入传染病护理是可行的、可接受的和有效的。然而，虽然该区域将重点转移到包括慢性病，但需要更多的信息将抑郁症服务纳入慢性病环境。我们评估了服务提供者对将抑郁症护理纳入马拉维非传染性疾病（NCD）诊所的概念的看法。这项分析的目的是更好地了解将抑郁症纳入NCD服务的障碍，促进因素和解决方案。在2018年6月至8月期间，我们对供应商进行了19次深入访谈。从马拉维中部地区的10家公立医院（即，每个诊所2人，但有一个诊所除外，因为时间安排上的困难，只有一个提供者接受了采访）。使用半结构化访谈指南，我们询问参与者有关他们对抑郁症的理解及其在诊所的管理的问题。我们使用主题分析，同时考虑到归纳和演绎的方法。出现的主题涉及促进者，障碍和建议的解决方案，将抑郁症评估和护理纳入非传染性疾病诊所。我们使用CFIR结构对促进因素和障碍进行分类。几乎所有的供应商都知道什么是抑郁症及其相关的体征和症状。几乎所有设施都有一个NCD专用房间，并报告说，将抑郁症纳入NCD护理是可行的。服务整合的促进因素包括非传染性疾病提供者整合服务的准备程度、诊所抗抑郁药的可用性。服务整合的障碍包括有限的知识和缺乏培训，抑郁症护理，人力和物力资源不足，高工作量的供应商和缺乏物理空间的一些抑郁症服务，特别是咨询。建议的解决方案是培训非传染性疾病的工作人员抑郁症的评估和护理，从事医院领导人创建一个非传染性疾病和抑郁症护理整合政策，将抑郁症信息整合到现有的文件，增加工作人员，并重组诊所流程。这项研究的结果表明，需要创新的实施科学的解决方案，如重组诊所流程，以提高质量和持续时间的病人与提供者的互动，以及持续的培训和监督，以增加临床知识。试验注册本研究报告了“撒哈拉以南非洲地区精神卫生能力建设伙伴关系（SHARP）-马拉维整合抑郁症护理策略的临床随机试验”形成阶段的部分结果，注册号为NCT 03711786。
Integration of depression services into infectious disease care is feasible, acceptable, and effective in sub-Saharan African settings. However, while the region shifts focus to include chronic diseases, additional information is required to integrate depression services into chronic disease settings. We assessed service providers’ views on the concept of integrating depression care into non-communicable diseases’ (NCD) clinics in Malawi. The aim of this analysis was to better understand barriers, facilitators, and solutions to integrating depression into NCD services. Between June and August 2018, we conducted nineteen in-depth interviews with providers. Providers were recruited from 10 public hospitals located within the central region of Malawi (i.e., 2 per clinic, with the exception of one clinic where only one provider was interviewed because of scheduling challenges). Using a semi structured interview guide, we asked participants questions related to their understanding of depression and its management at their clinic. We used thematic analysis allowing for both inductive and deductive approach. Themes that emerged related to facilitators, barriers and suggested solutions to integrate depression assessment and care into NCD clinics. We used CFIR constructs to categorize the facilitators and barriers. Almost all providers knew what depression is and its associated signs and symptoms. Almost all facilities had an NCD-dedicated room and reported that integrating depression into NCD care was feasible. Facilitators of service integration included readiness to integrate services by the NCD providers, availability of antidepressants at the clinic. Barriers to service integration included limited knowledge and lack of training regarding depression care, inadequacy of both human and material resources, high workload experienced by the providers and lack of physical space for some depression services especially counseling. Suggested solutions were training of NCD staff on depression assessment and care, engaging hospital leaders to create an NCD and depression care integration policy, integrating depression information into existing documents, increasing staff, and reorganizing clinic flow. Findings of this study suggest a need for innovative implementation science solutions such as reorganizing clinic flow to increase the quality and duration of the patient-provider interaction, as well as ongoing trainings and supervisions to increase clinical knowledge. Trial registration This study reports finding of part of the formative phase of “The Sub-Saharan Africa Regional Partnership (SHARP) for Mental Health Capacity Building—A Clinic-Randomized Trial of Strategies to Integrate Depression Care in Malawi” registered as NCT03711786
登录
查看更多内容
DOI：
10.1186/1748-5908-4-50
发表时间：
2009-08-07
期刊：
Implementation science : IS
影响因子：
--
作者：
Damschroder LJ;Aron DC;Keith RE;Kirsh SR;Alexander JA;Lowery JC
通讯作者：
Lowery JC
影响因子：
4.5
作者：
Crabb J;Stewart RC;Kokota D;Masson N;Chabunya S;Krishnadas R
通讯作者：
Krishnadas R
DOI：
10.1007/s10488-008-0197-4
发表时间：
2009-01
影响因子：
2.6
作者：
Proctor, Enola K.;Landsverk, John;Aarons, Gregory;Chambers, David;Glisson, Charles;Mittman, Brian
通讯作者：
Mittman, Brian
DOI：
10.1097/qad.0000000000000797
发表时间：
2015-09-24
期刊：
AIDS (London, England)
影响因子：
--
作者：
Pence BW;Gaynes BN;Adams JL;Thielman NM;Heine AD;Mugavero MJ;McGuinness T;Raper JL;Willig JH;Shirey KG;Ogle M;Turner EL;Quinlivan EB
通讯作者：
Quinlivan EB
影响因子：
3.6
作者：
Chibanda D;Verhey R;Munetsi E;Cowan FM;Lund C
通讯作者：
Lund C