Effect of collaborative care between traditional and faith healers and primary health-care workers on psychosis outcomes in Nigeria and Ghana (COSIMPO): a cluster randomised controlled trial.
Effect of collaborative care between traditional and faith healers and primary health-care workers on psychosis outcomes in Nigeria and Ghana (COSIMPO): a cluster randomised controlled trial.
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DOI：
10.1016/s0140-6736(20)30634-6
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发表时间：
2020-08-29
期刊：
影响因子：
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通讯作者：
Seedat S
中科院分区：
文献类型：
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作者：
Gureje O;Appiah-Poku J;Bello T;Kola L;Araya R;Chisholm D;Esan O;Harris B;Makanjuola V;Othieno C;Price L;Seedat S
我们评估了由传统和信仰治疗师（TFH）和初级卫生保健提供者（PHCW）提供的精神病协作共享护理（CSC）模式的有效性和成本效益。在加纳库马西和尼日利亚伊巴丹进行的随机对照试验。每个集群由一个初级保健诊所和邻近的TFH设施组成，按规模和国家分层，并随机分配（1：1）到由TFH和PHCW提供手动CSC的干预组或常规加强护理（eCAU）的对照组。参与者为TFH机构入院时具有活动性精神病症状（阳性和阴性精神分裂症综合征（PANSS）评分≥ 60）的成年人（年龄≥18岁）。在6个月时和个体水平进行PANSS和成本的设盲主要结局评估。试验注册号：ID：NCT 02895269随机分配51个组（26个干预组，25个对照组）。2016年9月1日至2017年5月3日期间入组了307例患者（干预组166例[54%]，对照组141例[47%]）; 190例（62%）为男性。CSC组和eCAU组的基线平均PANSS评分分别为107.3（SD 17.5）和108.9（SD 18.3）。286例（93%）完成了6个月随访，CSC组的平均总PANSS评分为53.4（SD 19.9），显著低于eCAU对照组的67.6（SD 23.3）（校正平均差异为-15.01（95%CI-21.17至-8.84; p<0.0001）。CSC参与者的平均PANSS阴性、阳性和一般精神病理学子量表评分也均显著较低。CSC导致整体护理成本的大幅降低。5名CSC参与者出现轻度锥体外系副作用。研究结果表明，由TFH和传统的医疗服务提供者为精神病患者提供的合作共享护理是有效的和具有成本效益的。这种护理模式提供了一种前景，可以在资源匮乏的情况下扩大对这一弱势群体的护理。国家精神卫生研究所。
We assessed the effectiveness and cost-effectiveness of a collaborative shared care (CSC) model for psychosis delivered by traditional and faith healers (TFH) and primary health care providers (PHCW). Cluster-randomized trial in Kumasi, Ghana and Ibadan, Nigeria. Clusters, each consisting of a primary care clinic and neighbouring TFH facilities, were stratified by size and country and randomly allocated (1:1) to either intervention group in which a manualised CSC was delivered by TFH and PHCW or control group with enhanced care as usual (eCAU). Participants were adults (aged ≥18 years) on admission in TFH facilities with active psychotic symptoms (Positive and Negative Schizophrenia Syndrome (PANSS) score ≥ 60). Blinded primary outcome assessments with PANSS and of costs were conducted at 6 months and at individual level. Trial registration number: ID:NCT02895269 51 clusters were randomly allocated (26 intervention, 25 control). 307 patients (166[54%] in the intervention group and 141[47%] in the control group) were enrolled between September 1, 2016 and May 3, 2017; 190(62%) were male. Baseline mean PANSS score was 107.3 (SD17.5) for CSC group and 108.9 (SD18.3) for eCAU group. 286 (93%) completed the 6-month follow-up at which the mean total PANSS score for CSC group was 53.4 (SD19.9), significantly lower than 67.6 (SD 23.3) for eCAU control group (adjusted mean difference −15.01 (95%CI −21.17to−8.84; p<0.0001). Mean PANSS negative, positive and general psychopathology sub-scale scores were also all significantly lower for CSC participants. CSC led to greater reductions in overall care costs. Mild extrapyramidal side effects were experienced by 5 CSC participants. Findings indicate that a collaborative shared care delivered by TFH and conventional health providers for persons with psychosis is effective and cost-effective. The model of care offers the prospect of scaling up improved care to this vulnerable population in settings with low resources. National Institute of Mental Health.