Practice facilitation and supervision to strengthen depression treatment in primary care in Zimbabwe

实行便利和监督，以加强津巴布韦初级保健中的抑郁症治疗

• 批准号: 10705311
• 负责人: Helen Elizabeth Jack
• 金额: $ 18.41万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-15 至 2027-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10705311
• 关键词: Address; Advisory Committees; Area; Care given by nurses; Cellular Phone; Child Care; Clinic; Clinical; Clinical Practice Guideline; Clinical Skills; Clinical Trials; Cluster Analysis; Cluster randomized trial; Collaborations; Complement; Country; Data; Data Collection; Dedications; Depression screen; Development; Diagnosis; Education; Evidence based treatment; Focus Groups; Friendships; Funding; Future; Guidelines; Health; Health Personnel; Healthcare; Internal Medicine; Interview; K-Series Research Career Programs; Literature; London; Measures; Mental Depression; Mental Health; Mental Health Services; Mental disorders; Mentors; Mentorship; Methods; Nurses; Outcome; Patients; Persons; Pharmaceutical Preparations; Phase; Population; Primary Care; Primary Health Care; Primary Nursing Care; Probability; Provider; Psychiatric Nursing; Psychiatrist; Psychological reinforcement; Psychotherapy; Publications; Randomized; Randomized, Controlled Trials; Research; Research Personnel; Research Project Grants; Resource-limited setting; Sampling; Series; Supervision; Surveys; Testing; Time; Training; Training Programs; Training Support; Treatment Cost; United States National Institutes of Health; Universities; Visit; Washington; Work; World Health Organization; X Inactivation; Zimbabwe; acceptability and feasibility; arm; behavioral health; clinical decision support; clinical practice; clinical training; cluster trial; college; design; effectiveness/implementation trial; evidence base; experience; health care delivery; human centered design; implementation barriers; implementation evaluation; implementation outcomes; implementation science; implementation strategy; improved; instructor; low and middle-income countries; mental health organization; pilot test; pilot trial; primary care clinic; primary care practice; programs; scale up; screening; treatment guidelines; trial design; uptake

PROJECT SUMMARY Background: Worldwide, the majority of people with depression receive no treatment, despite the existence of evidence-based, low-cost treatments. In Zimbabwe, at least a third of people presenting to primary care screen positive for depression, but most cases go unrecognized and untreated. Research strategy: This study includes the development and pilot testing of an implementation strategy to improve uptake of clinical guidelines for depression diagnosis and treatment in primary care. It has three phases: 1) Assessment of current practice: In a sample of patients presenting to routine primary care (n=200), determine what percent of patients with probable depression are recognized by primary care nurses and offered treatment, 2) Adaptation of an implementation strategy: Using a human-centered design (HCD) approach, conduct qualitative interviews and hold focus groups with nurses to iteratively adapt a implementation strategy that combines in-person practice facilitation with mobile phone-based clinical supervision, 3) Pilot trial of the implementation strategy: In order to evaluate whether the implementation strategy is feasible and acceptable and to inform a future cluster randomized trial of the strategy, pilot test the strategy in two clinics (n=12 nurses, n=30 patients), comparing outcomes to two control clinics (n=12 nurses, n=30 patients). Outcomes include a) feasibility and acceptability of the implementation strategy (qualitative interviews, surveys, and program data), b) exploratory implementation outcomes (e.g. depression screening, recognition, treatment receipt), c) exploratory clinical outcomes: PHQ-9 score of patients at 6 and 12 weeks after initial visit, and d) feasibility of data collection strategy. Training plan: To conduct the proposed research and transition to being an independent investigator, Dr. Jack will receive mentorship and training in the following areas: 1) foundational understanding of methods for the design and analysis of clustered clinical trials, 2) implementation science with a focus on mixed methods, and 3) human-centered design. Mentorship: Dr. Jack’s primary mentor (Rao) brings expertise in implementation science and global mental health in primary care, which is complemented by her co-mentors who are experts in depression research in Zimbabwe (Chibanda) and mental health treatment guidelines and clinical trials in low and middle income-countries (Thornicroft). She also has a scientific advisory team (Dorsey, Hallgren, and Lyon) who will support her training and research in implementation science, clustered trial design, and HCD, respectively. Candidate: Dr. Jack combines clinical training in Internal Medicine with a research background that has focused on global mental health and the integration of behavioral health into primary care (42 publications, 15 as first author). This K23 builds on her eight years of prior research in Zimbabwe and will allow her the dedicated time for research and training required to become an independent, NIH-funded investigator in implementation science to address the behavioral health treatment gap worldwide.

项目摘要 背景：在世界范围内，大多数抑郁症患者没有接受治疗，尽管存在 以证据为基础的低成本治疗在津巴布韦，至少有三分之一的人接受初级保健筛查 抑郁症呈阳性，但大多数病例未被识别和治疗。研究策略：本研究 包括制定和试点测试实施战略，以提高临床 初级保健中抑郁症诊断和治疗指南。它有三个阶段：1）评估 当前实践：在接受常规初级保健的患者样本（n=200）中，确定 可能患有抑郁症的患者被初级保健护士识别并提供治疗，2）适应 实施策略：使用以人为本的设计（HCD）方法，进行定性访谈 并与护士举行焦点小组会议，反复调整实施策略， 通过基于移动的电话的临床监督促进实践，3）实施策略的试点试验： 以评估实施战略是否可行和可接受，并为未来的集群提供信息 该策略的随机试验，在两个诊所（n=12名护士，n=30名患者）进行了初步测试，比较 两个对照诊所的结果（n=12名护士，n=30名患者）。结果包括a）可行性和可接受性 实施策略的评估（定性访谈、调查和项目数据），B）探索性 实施结果（例如抑郁症筛查、识别、接受治疗），c）探索性临床 结果：首次访视后6周和12周患者的PHQ-9评分，以及d）数据收集的可行性 战略培训计划：进行拟议的研究，并过渡到成为一个独立的 杰克博士将在以下领域接受指导和培训：1）基础知识 聚类临床试验的设计和分析方法，2）实施科学，重点是 混合方法; 3）以人为本的设计。导师：杰克博士的主要导师（饶）带来了专业知识 在初级保健中实施科学和全球精神卫生，这是由她的共同导师补充 他们是津巴布韦（奇班达）抑郁症研究和心理健康治疗指南的专家， 低收入和中等收入国家的临床试验（Thornicroft）。她还有一个科学顾问团队（多尔西， Hallgren和里昂），他们将支持她在实施科学、群集试验 设计和HCD。候选人：杰克博士将内科临床培训与 研究背景，重点是全球心理健康和整合行为健康， 初级保健（42篇出版物，15篇为第一作者）。K23建立在她之前八年的研究基础上， 津巴布韦，并将允许她专门的时间进行研究和培训，成为一个独立的， NIH资助的实施科学研究员，以解决全球行为健康治疗差距。