Wakida Edith K, Obua Celestino, Musisi Seggane, Rukundo Godfrey Z, Ssebutinde Peter, Talib Zohray M, Akena Dickens, Okello Elialilia S
1Department of Psychiatry, Mbarara University of Science and Technology, P. O. Box 1410, Mbarara, Uganda.
2Department of Pharmacology and Therapeutics and Vice Chancellor, Mbarara University of Science and Technology, Mbarara, Uganda.
Int J Ment Health Syst. 2019 Jul 17;13:49. doi: 10.1186/s13033-019-0304-9. eCollection 2019.
Clinical practice guidelines (CPG) are developed based on a synthesis of evidence regarding the best options for the assessment, diagnosis and treatment of diseases and are recognized as essential quality improvement tools. However, despite growing availability of CPG, research evaluating their use for mental disorders in Uganda is lacking. For a successful implementation of CPG to be achieved, a number of considerations need to be put in place.
This study aimed to assess the feasibility and acceptability of the educational intervention that we developed towards improvement of the primary health care providers (PHCPs) uptake of the Uganda Clinical Guidelines (UCG) in integrating mental health services into PHC in Mbarara district, southwestern Uganda.
This was a descriptive cross-sectional qualitative study with a semi-structured in-depth interview guide. The educational intervention we were assessing had four components: (i) summarized UCG on common mental disorders; (ii) modified Health Management Information System (HMIS) registers to include mental health; (iii) clinician's checklist outlining the steps to be followed; and iv) support supervision/training.
Six themes emerged from the study while the components of the intervention formed the apriori subthemes. Key results based on the subthemes show: (i) summarized UCG: the participants liked the packaging stating that it eased their work, was time saving and user friendly; (ii) modified register: participants appreciated the modifications made to the register updating the existing record in the Health Management Information System (HMIS) registers to include mental health disorders; (iii) TRAINING and support supervision: the PHCPs attributed the success in using the summarized UCG to the training they received, and they further expressed the need to regularize the training in assessment for mental health and support by the mental health specialists.
Our study demonstrates that the use of summarized UCG, modified HMIS registers to include mental health, training and support supervision by mental health specialists in implementing the UCG in integrating mental health at PHC settings is feasible and acceptable by the PHCPs in Mbarara district, southwestern Uganda. Given the need for improved mental health care in Uganda, this intervention could be rigorously evaluated for effectiveness, scalability and generalizability.
临床实践指南（CPG）是基于对疾病评估、诊断和治疗最佳选择的证据综合制定的，被视为重要的质量改进工具。然而，尽管CPG的可得性不断提高，但在乌干达，评估其在精神障碍方面应用的研究却很缺乏。要成功实施CPG，需要考虑多个因素。
本研究旨在评估我们开发的教育干预措施在乌干达西南部姆巴拉拉区将精神卫生服务纳入初级卫生保健（PHC）过程中，提高初级卫生保健提供者（PHCPs）对乌干达临床指南（UCG）采用率的可行性和可接受性。
这是一项采用半结构化深入访谈指南的描述性横断面定性研究。我们评估的教育干预措施有四个组成部分：（i）常见精神障碍的UCG摘要；（ii）修改后的健康管理信息系统（HMIS）登记册以纳入精神卫生内容；（iii）临床医生清单，概述应遵循的步骤；以及（iv）支持性监督/培训。
研究得出了六个主题，而干预措施的组成部分构成了先验子主题。基于这些子主题的关键结果显示：（i）UCG摘要：参与者喜欢其形式，称这简化了他们的工作，节省时间且用户友好；（ii）修改后的登记册：参与者赞赏对登记册所做的修改，即在健康管理信息系统（HMIS）登记册中更新现有记录以纳入精神障碍；（iii）培训和支持性监督：PHCPs将成功使用UCG摘要归功于他们接受的培训，他们还进一步表示需要规范精神卫生评估培训以及精神卫生专家的支持。
我们的研究表明，在乌干达西南部姆巴拉拉区的PHCPs中，使用UCG摘要、修改后的HMIS登记册以纳入精神卫生内容、由精神卫生专家进行培训和支持性监督，在初级卫生保健环境中实施UCG以整合精神卫生是可行且可接受的。鉴于乌干达改善精神卫生保健的需求，可对该干预措施的有效性、可扩展性和普遍性进行严格评估。
