Dr. Acharya, Ms. Rimal, and Dr. Swar are with Possible, Achham, Nepal. Dr. Acharya is also with the Department of Psychiatry, University of California, San Francisco (UCSF), where Dr. Ekstrand is with the Department of Medicine. Dr. Ali is with the Department of Global Health and Epidemiology, Emory University, Atlanta. Dr. Srinivasan is with St. Johns Research Institute, Bengaluru, Karnataka, India. Dr. Mohan is with the Department of Diabetology, Madras Diabetes Research Foundation, Chennai, Tamil Nadu, India. Dr. Unützer and Dr. Chwastiak are with the Department of Psychiatry and Behavioral Sciences, University of Washington Medical Center, Seattle.
Psychiatr Serv. 2017 Sep 1;68(9):870-872. doi: 10.1176/appi.ps.201700232. Epub 2017 Aug 1.
The collaborative care model is an evidence-based intervention for behavioral and other chronic conditions that has the potential to address the large burden of mental illness globally. Using the World Health Organization Health Systems Framework, the authors present challenges in implementing this model in low- and middle-income countries (LMICs) and discuss strategies to address these challenges based on experiences with three large-scale programs: an implementation research study in a district-level government hospital in rural Nepal, one clinical trial in 50 primary health centers in rural India, and one study in four diabetes clinics in India. Several strategies can be utilized to address implementation challenges and enhance scalability in LMICs, including mobilizing community resources, engaging in advocacy, and strengthening the overall health care delivery system.
协作式护理模式是一种针对行为和其他慢性疾病的循证干预措施，有可能减轻全球范围内的精神疾病负担。本文利用世界卫生组织卫生系统框架，提出了在中低收入国家（LMICs）实施该模式所面临的挑战，并根据在尼泊尔农村地区一个区级政府医院的实施研究、印度 50 个初级保健中心的一项临床试验以及印度四个糖尿病诊所的一项研究的经验，讨论了应对这些挑战的策略。可以利用多种策略来解决实施中的挑战并提高在 LMICs 的可扩展性，包括调动社区资源、开展宣传活动以及加强整体医疗服务提供系统。
