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Developing a tailored implementation plan for collaborative care of perinatal depression care in community health centers in Vietnam

制定越南社区卫生中心围产期抑郁症护理协作护理定制实施计划

基本信息

批准号：
10001618
负责人：
IAN Moore BENNETT
金额：
$ 16.08万
依托单位：
UNIVERSITY OF WASHINGTON
依托单位国家：
美国
项目类别：
财政年份：
2019
资助国家：
美国
起止时间：
2019-09-01 至 2022-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10001618
关键词：
Address Adult Affect Antidepressive Agents Award Awareness Caring Child Child Care Chronic Care Chronic Disease Cities Clinical Country Development Discipline of obstetrics Disease Drops Effectiveness Elements Evidence based treatment Faculty Feedback Growth Gynecologic Health Health Personnel Health Services Health system Healthcare Systems Heritability Hospitals Hybrids Impairment Infant Infrastructure Intervention Journals Learning Link Maternal Mortality Medical Medicine Mental Depression Mental Health Mental disorders Methods Modeling Neighborhood Health Center Outcome Outcome Measure Patients Perinatal Perinatal Care Persons Pharmaceutical Preparations Pharmacy facility Postpartum Period Pregnancy Prenatal care Primary Health Care Process Program Development Provider Public Health Publications Quality of Care Randomized Research Research Personnel Research Training Resources Risk Rivers Rural Self Care Service delivery model Service setting Source Structure Suicide Suicide prevention Training Training Programs United States National Institutes of Health Universities Vietnam Washington Woman Work World Health Organization base behavioral health care delivery care systems collaborative care community based participatory research community setting cost disability effective therapy effectiveness trial efficacy trial evidence base flexibility food insecurity health care delivery health information technology implementation research implementation science implementation strategy improved improved outcome individualized medicine innovation low and middle-income countries medical specialties meetings mental health organization novel peripartum depression pregnancy disorder programs prospective psychosocial research to practice screening service delivery skills social stigma suicidal risk tool voltage

项目摘要

Project Summary/Abstract Perinatal depression is a common and serious disorder, with suicide representing a major cause of maternal mortality, but few women from low and middle income countries (LMICs) receive effective treatment. Effective models of care that improve perinatal depression and support suicide prevention exist but have not yet been widely implemented in routine maternal-child care services in LMICs. These models include innovations to allow scarce specialty care to support high quality care in community settings and so are potentially well suited to low resourced countries. A major obstacle to achieving the benefits of these models is a lack of appropriate adaptation to the cultural and health services context of the settings in which they will be delivered. While evidence based models may work in the context in which they were developed maintaining too great an allegiance to fidelity without allowing adaptation can result in reduced effectiveness or “voltage drop” in new settings. In contrast, a focus on flexible adaptation of care approaches has the potential to achieve or even exceed the outcomes seen in controlled efficacy trials by supporting intervention “reinvention” within the context of a learning health system. Implementation strategies, in addition to the elements of the health service delivery itself, must also be appropriate to the cultural and health services context in which care innovations are to be introduced. We plan to use a participatory approach to systematically identify and adapt key elements of evidence based models of perinatal depression care delivery to the cultural and health services context of Can Tho, Vietnam. This federal-provincial city provides health services to a large region of the Mekong River Delta with over 19 million, mostly rural inhabitants. Over the two-year study period we will first develop a model, adapted from evidence based approaches, for screening and treatment for women receiving perinatal care in community health centers as well as obstetric hospitals. Simultaneous exploration of potential implementation strategies to support and sustain this model in context will be identified along with the creation of a training and implementation toolkit for this setting. Using these strategies and tools we will then carry out a pilot perinatal collaborative care study in a public health center and the prenatal care practice of the Can Tho Obstetric and Gynecologic Hospital. The results of this pilot will be used to revise and enhance the treatment model and related implementation tools. These will be used in subsequent trials of effectiveness and/or implementation broadly in the health care system of Can Tho.

项目摘要/摘要围产期抑郁是一种常见和严重的疾病，自杀是母亲死亡的主要原因死亡率有所下降，但低收入和中等收入国家很少有妇女得到有效治疗。有效改善围产期抑郁和支持自杀预防的护理模式已经存在，但尚未得到在小岛屿发展中国家的常规母婴保健服务中广泛实施。这些模式包括以下创新允许稀缺的专科护理支持社区环境中的高质量护理，因此可能非常适合到资源匮乏的国家。实现这些模式的好处的一个主要障碍是缺乏适当的适应将提供这些服务的环境的文化和卫生服务背景。而当基于证据的模型可能会在它们开发的背景下工作，维护太大的在不允许适应的情况下忠于保真度可能会导致新的设置。相比之下，关注护理方法的灵活适应有可能实现甚至超过受控疗效试验的结果，支持在一个学习型卫生系统的背景。除保健服务的要素外，执行战略提供服务本身也必须适合保健创新所处的文化和卫生服务背景将会被介绍给。我们计划使用参与性方法来系统地确定和调整关键要素在文化和卫生服务背景下提供围产期抑郁症护理的循证模式越南的坎托。这座联邦-省级城市为湄公河的一大片地区提供医疗服务三角洲地区有1900多万人口，其中大部分是农村居民。在为期两年的研究期间，我们将首先制定一项从循证方法改编而来的围产期妇女筛查和治疗模式社区卫生中心以及产科医院的护理。潜力的同时发掘将在创建过程中确定支持和维持该模式的实施战略针对这一环境的培训和实施工具包。使用这些策略和工具，我们将实施某公共卫生中心围产期协作护理试点研究及围产期护理实践妇产科医院。这项试点的结果将用于修订和加强治疗模型和相关实现工具。这些将用于随后的有效性试验和/或在CANTHO的医疗保健系统中广泛实施。