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

项目总结 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 循证、低成本的治疗方法。在津巴布韦，至少三分之一的人到初级保健机构接受筛查 抑郁症呈阳性，但大多数病例没有被发现，也没有得到治疗。研究策略：本研究 包括制定和试行实施战略，以提高对临床的接受度 初级保健中抑郁症诊断和治疗指南。它有三个阶段：1)评估 当前做法：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得到初级保健护士的认可并提供治疗，2)适应 实施战略：使用以人为中心的设计(HCD)方法，进行定性访谈 与护士一起举办焦点小组，反复调整结合面对面的实施策略 以手机为基础的临床监督的实践便利化，3)实施战略的试点试验： 以评估执行战略是否可行和可接受，并为未来的分组提供信息 该策略的随机试验，在两个诊所(n=12名护士，n=30名患者)进行预试，比较 两个对照诊所(n=12名护士，n=30名患者)的结果。结果包括a)可行性和可接受性 实施战略(定性访谈、调查和方案数据)，b)探索性 实施结果(例如，抑郁症筛查、识别、治疗收据)，c)探索性临床 结果：初诊后6周和12周患者的PHQ-9评分，以及d)数据收集的可行性 策略。培训计划：进行拟议的研究并过渡到独立的 作为调查员，Jack博士将在以下方面接受指导和培训：1)基础理解 设计和分析成组临床试验的方法，2)实施科学，重点是 混合方法，3)以人为本的设计。导师关系：杰克博士的主要导师(RAO)带来了专业知识 在初级保健的实施科学和全球心理健康方面，她的共同导师补充了这一点 世卫组织是津巴布韦(奇班达)抑郁症研究和精神健康治疗指南和 低收入和中等收入国家的临床试验(Thornmicroft)。她还有一个科学顾问团队(多尔西， Hallgren和Lyon)，谁将支持她在实施科学、集群试验方面的培训和研究 Design和HCD。应聘者：杰克医生将内科的临床培训与 研究背景，重点是全球心理健康和将行为健康纳入 初级保健(42份出版物，15份第一作者)。这个K23建立在她之前八年的研究基础上 并将允许她有专门的时间进行研究和培训，以成为一名独立的 NIH资助的实施科学研究人员，以解决世界范围内的行为健康治疗缺口。

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.