Ahmad Farah, Lou Wendy, Shakya Yogendra, Ginsburg Liane, Ng Peggy T, Rashid Meb, Dinca-Panaitescu Serban, Ledwos Cliff, McKenzie Kwame
School of Health Policy and Management (Ahmad, Ginsburg, Dinca-Panaitescu), York University; Biostatistics Division (Lou), Dalla Lana School of Public Health, University of Toronto; Access Alliance Multicultural Health and Community Services (Shakya, Ledwos); School of Administrative Studies (Ng), York University; Women's College Hospital (Rashid); Department of Family and Community Medicine (Rashid), University of Toronto; Centre for Addiction and Mental Health (McKenzie); The Wellesley Institute (McKenzie), Toronto, Ont.
CMAJ Open. 2017 Mar 1;5(1):E190-E197. doi: 10.9778/cmajo.20160118. eCollection 2017 Jan-Mar.
Access disparities for mental health care exist for vulnerable ethnocultural and immigrant groups. Community health centres that serve these groups could be supported further by interactive, computer-based, self-assessments.
An interactive computer-assisted client assessment survey (iCCAS) tool was developed for preconsult assessment of common mental disorders (using the Patient Health Questionnaire [PHQ-9], Generalized Anxiety Disorder 7-item [GAD-7] scale, Primary Care Post-traumatic Stress Disorder [PTSD-PC] screen and CAGE [concern/cut-down, anger, guilt and eye-opener] questionnaire), with point-of-care reports. The pilot randomized controlled trial recruited adult patients, fluent in English or Spanish, who were seeing a physician or nurse practitioner at the partnering community health centre in Toronto. Randomization into iCCAS or usual care was computer generated, and allocation was concealed in sequentially numbered, opaque envelopes that were opened after consent. The objectives were to examine the interventions' efficacy in improving mental health discussion (primary) and symptom detection (secondary). Data were collected by exit survey and chart review.
Of the 1248 patients assessed, 190 were eligible for participation. Of these, 148 were randomly assigned (response rate 78%). The iCCAS ( = 75) and usual care ( = 72) groups were similar in sociodemographics; 98% were immigrants, and 68% were women. Mental health discussion occurred for 58.7% of patients in the iCCAS group and 40.3% in the usual care group ( ≤ 0.05). The effect remained significant while controlling for potential covariates (language, sex, education, employment) in generalized linear mixed model (GLMM; adjusted odds ratio [OR] 2.2; 95% confidence interval [CI] 1.1-4.5). Mental health symptom detection occurred for 38.7% of patients in the iCCAS group and 27.8% in the usual care group ( > 0.05). The effect was not significant beyond potential covariates in GLMM (adjusted OR 1.9; 95% CI 0.9-4.1).
The studied intervention holds potential for community health centres to improve mental health discussion. Further research with larger samples should examine the impact on detection and enhance generalizability. ClinicalTrials.gov, no: NCT02023957, registered on Dec. 12, 2013.
弱势种族文化群体和移民群体在获得心理健康护理方面存在差异。为这些群体提供服务的社区卫生中心可以通过交互式的、基于计算机的自我评估得到进一步支持。
开发了一种交互式计算机辅助客户评估调查（iCCAS）工具，用于对常见精神障碍进行咨询前评估（使用患者健康问卷[PHQ-9]、广泛性焦虑症7项量表[GAD-7]、初级保健创伤后应激障碍筛查量表[PTSD-PC]和CAGE问卷[关心/减少饮酒量、愤怒、内疚和警醒]），并生成即时护理报告。这项试点随机对照试验招募了在多伦多合作社区卫生中心就诊的、英语或西班牙语流利的成年患者。通过计算机生成随机分组，将患者随机分为iCCAS组或常规护理组，并将分配情况隐藏在按顺序编号的不透明信封中，在获得同意后打开信封。目的是检验干预措施在改善心理健康讨论（主要目标）和症状检测（次要目标）方面的效果。通过出院调查和病历审查收集数据。
在评估的1248名患者中，190名符合参与条件。其中，148名被随机分配（应答率78%）。iCCAS组（n = 75）和常规护理组（n = 72）在社会人口统计学特征方面相似；98%为移民，68%为女性。iCCAS组58.7%的患者进行了心理健康讨论，常规护理组为40.3%（P≤0.05）。在广义线性混合模型（GLMM）中控制潜在协变量（语言、性别、教育程度、就业情况）后，该效应仍然显著（调整后的优势比[OR]为2.2；95%置信区间[CI]为1.1 - 4.5）。iCCAS组38.7%的患者检测到心理健康症状，常规护理组为27.8%（P>0.05）。在GLMM中，该效应在考虑潜在协变量后不显著（调整后的OR为1.9；95%CI为0.9 - 4.1）。
所研究的干预措施有可能帮助社区卫生中心改善心理健康讨论。应进行更大样本量的进一步研究，以检验其对症状检测的影响并提高研究结果的普遍性。ClinicalTrials.gov编号：NCT02023957，于2013年12月12日注册。
