Zanmi Lasante, Mirebalais, Haiti.
Department of Psychiatry, University of California San Diego, La Jolla, CA, United States of America.
PLoS One. 2018 Jun 20;13(6):e0199313. doi: 10.1371/journal.pone.0199313. eCollection 2018.
This study evaluates the use of a mental health mobile clinic to overcome two major challenges to the provision of mental healthcare in resource-limited settings: the shortage of trained specialists; and the need to improve access to safe, effective, and culturally sound care in community settings. Employing task-shifting and supervision, mental healthcare was largely delivered by trained, non-specialist health workers instead of specialists. A retrospective chart review of 318 unduplicated patients assessed and treated during the mobile clinic's first two years (January 2012 to November 2013) was conducted to explore outcomes. These data were supplemented by a quality improvement questionnaire, illustrative case reports, and a qualitative interview with the mobile clinic's lead community health worker. The team evaluated an average of 42 patients per clinic session. The most common mental, neurological, or substance abuse (MNS) disorders were depression and epilepsy. Higher follow-up rates were seen among those with diagnoses of bipolar disorder and neurological conditions, while those with depression or anxiety had lower follow-up rates. Persons with mood disorders who were evaluated on at least two separate occasions using a locally developed depression screening tool experienced a significant reduction in depressive symptoms. The mental health mobile clinic successfully treated a wide range of MNS disorders in rural Haiti and provided care to individuals who previously had no consistent access to mental healthcare. Efforts to address these common barriers to the provision of mental healthcare in resource-limited settings should consider supplementing clinic-based with mobile services.
本研究评估了心理健康流动诊所的使用，以克服资源有限环境中提供精神卫生保健的两个主要挑战：训练有素的专家短缺；以及需要改善社区环境中安全、有效和文化上适当的护理的可及性。通过任务转移和监督，主要由受过培训的非专业卫生工作者而不是专家来提供精神卫生保健。对流动诊所头两年（2012 年 1 月至 2013 年 11 月）期间评估和治疗的 318 名非重复患者进行了回顾性图表审查，以探讨结果。这些数据通过质量改进问卷、说明性病例报告以及对流动诊所的主要社区卫生工作者的定性访谈进行了补充。该团队平均每次诊所就诊评估 42 名患者。最常见的精神、神经或物质滥用（MNS）障碍是抑郁症和癫痫。双相情感障碍和神经疾病诊断的随访率较高，而抑郁症或焦虑症的随访率较低。使用当地开发的抑郁筛查工具对至少两次单独就诊的心境障碍患者进行评估，发现其抑郁症状显著减轻。心理健康流动诊所成功治疗了海地农村地区的各种 MNS 障碍，并为以前没有持续获得精神卫生保健的人提供了护理。为解决资源有限环境中提供精神卫生保健的这些常见障碍而做出的努力应考虑在以诊所为基础的服务之外补充流动服务。
