Maconick Lucy, Jenkins Louis S, Fisher Henriette, Petrie Anthony, Boon Lynnie, Reuter Hermann
Improving Global Health, NHS Thames Valley and Wessex Leadership Academy.
Afr J Prim Health Care Fam Med. 2018 May 24;10(1):e1-e7. doi: 10.4102/phcfm.v10i1.1660.
Integrating mental health into primary care is a global priority. It is proposed to 'task-share' the screening, diagnosis and treatment of common mental disorders fromspecialists to primary care workers. Key to facilitating this is training primary care workers to deliver mental health care. Mental health training in Africa shows a predominance of short-term, externally driven training programmes. Locally, a more sustainable delivery system was needed.
The aim of the study was to develop and evaluate a locally delivered, long-term, inservice training programme to facilitate mental health care in primary care.
This was a quasi-experimental study using mixed methods. The in-service training programme was delivered in weekly 1-h sessions by local psychiatry staff to 20 primary care nurses at the clinic over 5 months. The training was evaluated using quantitative data from participant questionnaires and analysis of the referrals from primary to specialist care. Qualitative data were collected via semi-structured interviews and 14 observed training sessions.
The training was feasible and well received. Referrals to the mental health nurse increased in quality and participants' self-rated competence improved. Additional benefits included the development of supervision skills of mental health nurses and providing a forum for staff to discuss service improvement. The programme acted as a vehicle to pilot integration in one clinic and identify unanticipated barriers prior to rollout.
Long-term, in-service training, using existing local staff had benefits to the integration of mental health into primary care. This approach could be relevant to similar contexts elsewhere.
将精神卫生纳入初级保健是一项全球优先事项。有人提议将常见精神障碍的筛查、诊断和治疗工作从专科医生“任务分担”给初级保健工作者。促进这一转变的关键在于培训初级保健工作者提供精神卫生保健服务。非洲的精神卫生培训主要是短期的、由外部推动的培训项目。在当地，需要一个更具可持续性的服务提供系统。
本研究的目的是开发并评估一个由当地提供的长期在职培训项目，以促进初级保健中的精神卫生保健。
这是一项采用混合方法的准实验研究。在职培训项目由当地精神科工作人员以每周1小时的课程形式，在5个月内为诊所的20名初级保健护士提供培训。通过参与者问卷的定量数据以及对从初级保健转诊至专科保健的分析来评估培训效果。定性数据通过半结构化访谈和14次观察到的培训课程收集。
该培训可行且受到好评。转诊至精神卫生护士处的质量有所提高，参与者的自我评估能力也有所提升。其他益处包括精神卫生护士监督技能的发展，以及为工作人员提供一个讨论服务改进的平台。该项目成为了在一个诊所试点整合并在推广前识别意外障碍的工具。
利用现有的当地工作人员进行长期在职培训，对将精神卫生纳入初级保健有诸多益处。这种方法可能适用于其他类似情况。
