Hunt Justin B, Curran Geoffrey, Kramer Teresa, Mouden Sip, Ward-Jones Susan, Owen Richard, Fortney John
Division of Health Services Research, Psychiatric Research Institute, University of Arkansas for Medical Sciences, USA.
Prog Community Health Partnersh. 2012 Fall;6(3):389-98. doi: 10.1353/cpr.2012.0039.
Mental health and substance abuse are among the most commonly reported reasons for visits to Federally Qualified Health Centers (CHCs), yet only 6.5% of encounters are with on-site behavioral health specialists. Rural CHCs are significantly less likely to have on-site behavioral specialists than urban CHCs. Because of this lack of mental health specialists in rural areas, the most promising approach to improving mental health outcomes is to help rural primary care (PC) providers deliver evidence-based practices (EBPs). Despite the scope of these problems, no research has developed an effective implementation strategy for facilitating the adoption of mental health EBPs for rural CHCs. We sought to describe the conceptual components of an implementation partnership that focuses on the adaption and adoption of mental health EBPs by rural CHCs in Arkansas.
We present a conceptual model that integrates seven separate frameworks: (1) Jones and Wells' Evidence-Based Community Partnership Model, (2) Kitson's Promoting Action on Research Implementation in Health Services (PARiHS) implementation framework, (3) Sackett's definition of evidence-based medicine, (4) Glisson's organizational social context model, (5) Rubenstein's Evidence-Based Quality Improvement (EBQI) facilitation process, (6) Glasgow's RE-AIM evaluation approach, and (7) Naylor's concept of shared decision making.
By integrating these frameworks into a meaningful conceptual model, we hope to develop a successful implementation partnership between an academic health center and small rural CHCs to improve mental health outcomes. Findings from this implementation partnership should have relevance to hundreds of clinics and millions of patients, and could help promote the sustained adoption of EBPs across rural America.
心理健康和药物滥用是前往联邦合格健康中心（CHC）就诊最常被报告的原因之一，但只有6.5%的诊疗是与现场行为健康专家进行的。农村CHC配备现场行为专家的可能性明显低于城市CHC。由于农村地区缺乏心理健康专家，改善心理健康结果最有前景的方法是帮助农村初级保健（PC）提供者实施循证实践（EBP）。尽管存在这些问题，但尚无研究制定出有效的实施策略来促进农村CHC采用心理健康EBP。我们试图描述一种实施伙伴关系的概念组成部分，该伙伴关系专注于阿肯色州农村CHC对心理健康EBP的调整和采用。
我们提出一个整合了七个独立框架的概念模型：（1）琼斯和韦尔斯的循证社区伙伴关系模型，（2）基特森的促进卫生服务研究实施行动（PARiHS）实施框架，（3）萨克特对循证医学的定义，（4）格利森的组织社会背景模型，（5）鲁宾斯坦的循证质量改进（EBQI）促进过程，（6）格拉斯哥的RE-AIM评估方法，以及（7）内勒的共同决策概念。
通过将这些框架整合到一个有意义的概念模型中，我们希望在学术健康中心和农村小型CHC之间建立一个成功的实施伙伴关系，以改善心理健康结果。该实施伙伴关系的研究结果应与数百个诊所和数百万患者相关，并有助于促进全美国农村地区持续采用EBP。
