Integration of a Technology-Based Mental Health Screening Program Into Routine Practices of Primary Health Care Services in Peru (The Allillanchu Project): Development and Implementation.
Integration of a Technology-Based Mental Health Screening Program Into Routine Practices of Primary Health Care Services in Peru (The Allillanchu Project): Development and Implementation.
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DOI：
10.2196/jmir.9208
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发表时间：
2018-03-15
影响因子：
7.4
通讯作者：
Miranda JJ
中科院分区：
文献类型：
--
作者：
Diez-Canseco F;Toyama M;Ipince A;Perez-Leon S;Cavero V;Araya R;Miranda JJ
尽管抑郁症等精神疾病的患病率很高，负担沉重，但在很大程度上仍然没有得到充分的诊断和治疗。Allillancu项目的目的是设计、开发和测试一种干预措施，以促进在秘鲁利马接受公共初级卫生保健(PHC)服务的精神障碍患者的早期发现、时机转介和获得治疗。该项目有一个多阶段的设计：形成性研究、干预组件的开发和实施。干预措施结合了三项战略：培训初级保健提供者(PHCP)，转移检测和转诊精神障碍的任务，以及移动健康(MHealth)组成部分，包括筛查应用程序，然后是激励和提醒短消息服务(SMS)，以识别高危患者。这项干预是由来自五个卫生中心的22名初级保健医生实施的，他们在产前护理、结核病、慢性病和艾滋病毒或艾滋病服务部门工作。在2015年9月至2015年11月的9周时间里，22个初级保健医生在常规会诊期间对733名患者进行了筛查，总共完成了762次筛查。慢性病(49.9%，380/762)和产前保健服务(36.7%，380/762)筛查次数较多。时间限制和工作量是实施筛查的主要障碍，而研究小组使用技术、培训和监督公私伙伴关系被确定为促进者。在733名患者中，21.7%(159/733)筛查呈阳性，并被建议寻求专门护理。在159名筛查结果为阳性的患者中，127人进行了随访，72.4%(92/127)报告寻求专科治疗，55.1%(70/127)表示看专家。患者和初级保健医生都认识到筛查的作用，并确定了更广泛实施筛查的一些关键挑战。使用由培训和监督支持的筛查APP是可行的，并揭示了初级保健中不明心理症状的高患病率。为了增加其可持续性和实用性，可将这一程序纳入现有保健服务的常规做法，并根据每项服务的资源和特点进行调整。在定期会诊期间通过初级保健中心及早发现心理症状，然后提供充分的咨询和支持，可使相当大比例的患者获得专门护理，并缩小精神障碍的治疗差距。
Despite their high prevalence and significant burden, mental disorders such as depression remain largely underdiagnosed and undertreated. The aim of the Allillanchu Project was to design, develop, and test an intervention to promote early detection, opportune referral, and access to treatment of patients with mental disorders attending public primary health care (PHC) services in Lima, Peru. The project had a multiphase design: formative study, development of intervention components, and implementation. The intervention combined three strategies: training of PHC providers (PHCPs), task shifting the detection and referral of mental disorders, and a mobile health (mHealth) component comprising a screening app followed by motivational and reminder short message service (SMS) to identify at-risk patients. The intervention was implemented by 22 PHCPs from five health centers, working in antenatal care, tuberculosis, chronic diseases, and HIV or AIDS services. Over a period of 9 weeks, from September 2015 to November 2015, 733 patients were screened by the 22 PHCPs during routine consultations, and 762 screening were completed in total. The chronic diseases (49.9%, 380/762) and antenatal care services (36.7%, 380/762) had the higher number of screenings. Time constraints and workload were the main barriers to implementing the screening, whereas the use of technology, training, and supervision of the PHCPs by the research team were identified as facilitators. Of the 733 patients, 21.7% (159/733) screened positively and were advised to seek specialized care. Out of the 159 patients with a positive screening result, 127 had a follow-up interview, 72.4% (92/127) reported seeking specialized care, and 55.1% (70/127) stated seeing a specialist. Both patients and PHCPs recognized the utility of the screening and identified some key challenges to its wider implementation. The use of a screening app supported by training and supervision is feasible and uncovers a high prevalence of unidentified psychological symptoms in primary care. To increase its sustainability and utility, this procedure can be incorporated into the routine practices of existing health care services, following tailoring to the resources and features of each service. The early detection of psychological symptoms by a PHCP within a regular consultation, followed by adequate advice and support, can lead to a significant percentage of patients accessing specialized care and reducing the treatment gap of mental disorders.
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影响因子：
3.7
作者：
Andrews G;Cuijpers P;Craske MG;McEvoy P;Titov N
通讯作者：
Titov N
影响因子：
6.6
作者：
Cripe, Swee May;Sanchez, Sixto;Williams, Michelle A.
通讯作者：
Williams, Michelle A.
影响因子：
3.7
作者：
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通讯作者：
De Silva MJ
DOI：
10.2471/blt.12.104133
发表时间：
2012-11-01
期刊：
Bulletin of the World Health Organization: International Journal of Public Health
影响因子：
--
作者：
Buttorff, Christine;Hock, Rebecca S;Patel, Vikram
通讯作者：
Patel, Vikram
影响因子：
5
作者：
Adepoju, Ibukun-Oluwa Omolade;Albersen, Bregje Joanna Antonia;Zweekhorst, Marjolein
通讯作者：
Zweekhorst, Marjolein