Department of Psychiatry, Mbarara University of Science and Technology, Mbarara, Uganda.
Department of Medical Education, California University of Science and Medicine, California, USA.
Syst Rev. 2018 Nov 28;7(1):211. doi: 10.1186/s13643-018-0882-7.
The objective of the review was to synthesize evidence of barriers and facilitators to the integration of mental health services into PHC from existing literature. The structure of the review was guided by the SPIDER framework which involves the following: Sample or population of interest-primary care providers (PCPs); Phenomenon of Interest-integration of mental health services into primary health care (PHC); Design-influenced robustness and analysis of the study; Evaluation-outcomes included subjective outcomes (views and attitudes); and Research type-qualitative, quantitative, and mixed methods studies.
Studies that described mental health integration in PHC settings, involved primary care providers, and presented barriers/facilitators of mental health integration into PHC were included in the review. The sources of information included PubMed, PsycINFO, Cochrane Central Register of Controlled trials, the WHO website, and OpenGrey. Assessment of bias and quality was done using two separate tools: the Critical Appraisal Skills Program (CASP) qualitative checklist and the Effective Public Health Practice Project Quality Assessment Tool for Quantitative Studies.
Twenty studies met the inclusion criteria out of the 3353 search results. The most frequently reported barriers to integration of mental health services into PHC were (i) attitudes regarding program acceptability, appropriateness, and credibility; (ii) knowledge and skills; (iii) motivation to change; (iv) management and/or leadership; and (v) financial resources. In order to come up with an actionable approach to addressing the barriers, these factors were further analyzed along a behavior change theory.
We have shown that the integration of mental health services into PHC has been carried out by various countries. The analysis from this review provides evidence to inform policy on the existing barriers and facilitators to the implementation of the mental health integration policy option. Not all databases may have been exhausted.
PROSPERO 2016 (Registration Number: CRD42016052000 ) and published in BMC Systematic Reviews August 2017.
本综述的目的是综合现有文献中关于将精神卫生服务整合到初级卫生保健中的障碍和促进因素的证据。本综述的结构遵循 SPIDER 框架，包括以下内容：感兴趣的样本或人群-初级保健提供者（PCP）；感兴趣的现象-将精神卫生服务整合到初级卫生保健中（PHC）；设计-研究的稳健性和分析的影响；评估-结果包括主观结果（观点和态度）；以及研究类型-定性、定量和混合方法研究。
本综述纳入了描述 PHC 环境中精神卫生整合、涉及初级保健提供者并提出精神卫生整合到 PHC 中的障碍/促进因素的研究。信息来源包括 PubMed、PsycINFO、Cochrane 中央对照试验注册、世界卫生组织网站和 OpenGrey。使用两个独立的工具评估偏倚和质量：批判性评价技能计划（CASP）定性清单和有效公共卫生实践项目定量研究质量评估工具。
在 3353 项搜索结果中，有 20 项研究符合纳入标准。将精神卫生服务整合到 PHC 中最常报道的障碍包括：（i）对项目可接受性、适当性和可信度的态度；（ii）知识和技能；（iii）改变的动机；（iv）管理和/或领导力；以及（v）财务资源。为了提出一种切实可行的方法来解决这些障碍，我们进一步沿着行为改变理论对这些因素进行了分析。
我们已经表明，将精神卫生服务整合到 PHC 已经在许多国家进行。本综述的分析提供了证据，为实施精神卫生整合政策选项的现有障碍和促进因素提供了政策依据。并非所有数据库都已穷尽。
PROSPERO 2016（注册号：CRD42016052000），并于 2017 年 8 月发表在 BMC 系统评价中。
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