Randomized Control Trial on Implementation Strategies for Task-Shifting Depression Care in Vietnam

越南任务转移抑郁症护理实施策略的随机对照试验

• 批准号: 10244889
• 负责人: Victoria Khanh Ngo
• 金额: $ 63.05万
• 依托单位: GRADUATE SCHOOL OF PUBLIC HEALTH AND HEALTH POLICY
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-07-01 至 2023-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10244889
• 关键词: Accounting; Address; Adopted; Adoption; Canada; Caring; Clinic; Collaborations; Communities; Community Health; Competence; Country; Depressed mood; Educational workshop; Effectiveness; Effectiveness of Interventions; Evaluation; Evidence based intervention; Funding; Government; Health; Health Personnel; Health Resources; Health system; Healthcare; Healthcare Systems; Human Resources; Income; Individual; Intervention; Knowledge; Lead; Leadership; Learning; Maintenance; Measures; Mental Depression; Mental Health; Methods; Mission; Modeling; National Institute of Mental Health; Organizational Culture; Ownership; Patient-Focused Outcomes; Patients; Policies; Population; Primary Health Care; Problem Solving; Provider; Psychiatric Hospitals; Psychiatrist; Randomized; Research; Resistance; Resources; Rest; Self Efficacy; Services; Supervision; System; Testing; Time; Training; Vietnam; Work; Workload; World Bank; base; care burden; care providers; collaborative care; community engagement; compare effectiveness; control trial; cost; cost effectiveness; depression model; economic cost; effectiveness implementation study; implementation barriers; implementation determinants; implementation efforts; implementation evaluation; implementation intervention; implementation outcomes; implementation science; implementation strategy; implementation study; improved; improved outcome; incremental cost-effectiveness; innovation; literacy; low and middle-income countries; patient population; programs; provider factors; scale up; virtual

Research Abstract Depression is the single largest health care burden in the world, with no other illness accounting for even half its burden. Recently, the World Bank, WHO, Grand Challenges of Canada, and NIMH highlighted the crippling economic costs of unaddressed depression and the need to scale up depression care globally. In Vietnam, we found collaborative care effective and conducted a clustered randomized control trial (RCT) that has shown large effect sizes for a Multicomponent Collaborative Care Model for Depression (MCCD), in which depression care was task-shifted to primary care providers in local community health clinics and supported by mobile psychiatrists. While the benefits of collaborative care for depression are well-established, the most appropriate and effective implementation strategies for scaling up this model have not been identified. To address this need, our R01 proposal will build on our team's previous work on the MCCD and leverage current policy initiatives related to depression care in Vietnam—Grand Challenges of Canada, GCC, funding, which includes 80% matched funds supported by the Vietnamese health care system to support establishing a Center of Excellence at Danang Psychiatric Hospital and scaling up another NIMH R34 Depression program (LIFE- DM)—to identify implementation models most likely to lead to successful implementation and sustainment of effective services in low-resource settings. We will partner with local and national community and government organizations to conduct an RCT comparing effectiveness of three implementation models: (a) usual implementation (UI), which typically includes one workshop and toolkit; (b) enhanced supervision (ES; includes model UI); and (c) community-engaged learning collaborative (CELC; includes ES). According to the RE-AIM Implementation Evaluation framework, to have a population-level impact, an EBI must be adopted by providers, reach a large proportion of the targeted patient population, be implemented with fidelity, effectively improve outcomes, and be maintained after research funds are withdrawn. Thus, we will assess implementation outcomes at the organizational, provider, and patient levels based on this framework, assess organizational and provider factors associated with successful implementation, and measure the incremental cost-effectiveness of each implementation strategy. Doing this can guide policy decisions on best strategies to support scale-up of collaborative care models for depression and other EBIs. This comprehensive and rigorous implementation effectiveness study will contribute to our understanding of the added value of using a CELC strategy over and above the best practice in training (ES), which has not been done even in high-income countries. This timely evaluation of an depression care task-shifting will provide much needed knowledge about what implementation strategies and factors promote adoption, delivery, and sustainment of high-quality depression care in low-resource settings where limited mental health human resources are available, thus addressing global priority knowledge gaps in implementation science and mental health research.

研究摘要 抑郁症是世界上最大的医疗保健负担，没有其他疾病占到一半 它的负担。最近，世界银行、世界卫生组织、加拿大重大挑战和国家卫生研究院强调了这一严重后果 未得到解决的抑郁症的经济成本以及在全球范围内扩大抑郁症护理的必要性。在越南，我们 发现协作护理有效，并进行了一项集群随机对照试验 (RCT)，结果表明 抑郁症多成分协作护理模型 (MCCD) 的大效应量，其中抑郁症 护理任务转移给当地社区卫生诊所的初级保健提供者，并得到移动设备的支持 精神科医生。虽然协作护理对抑郁症的好处是众所周知的，但最合适的 尚未确定扩大该模式的有效实施策略。为了解决这个问题 根据需要，我们的 R01 提案将建立在我们团队之前在 MCCD 上的工作的基础上，并利用当前的政策 与越南抑郁症护理相关的举措——加拿大、海湾合作委员会、资金的重大挑战，其中包括 越南医疗保健系统支持的 80% 配套资金用于支持建立一个中心 岘港精神病医院的卓越表现并扩大另一个 NIMH R34 抑郁症项目（LIFE- DM）——确定最有可能成功实施和维持的实施模型 在资源匮乏的环境中提供有效的服务。我们将与地方和国家社区及政府合作 组织开展随机对照试验，比较三种实施模式的有效性：(a) 通常 实施 (UI)，通常包括一个研讨会和工具包； (b) 加强监督（ES； 包括模型 UI）； (c) 社区参与学习协作（CELC；包括 ES）。根据 RE-AIM 实施评估框架，为了产生人口层面的影响，必须采用 EBI 提供者，覆盖大部分目标患者群体，忠实、有效地实施 改善成果，并在研究经费撤回后维持。因此，我们将评估 基于此框架在组织、提供者和患者层面的实施结果，评估 与成功实施相关的组织和提供商因素，并衡量增量 每个实施策略的成本效益。这样做可以指导最佳战略的政策决策 支持扩大针对抑郁症和其他 EBI 的协作护理模式。这个全面而严谨的 实施有效性研究将有助于我们了解使用 CELC 的附加值 超越培训最佳实践（ES）的策略，即使在高收入国家也没有这样做 国家。对抑郁症护理任务转移的及时评估将提供急需的知识 关于哪些实施策略和因素可以促进高质量的采用、交付和维持 在精神卫生人力资源有限的资源匮乏地区进行抑郁症护理，因此 解决实施科学和心理健康研究方面的全球优先知识差距。