顾问精神科医生为改善尼泊尔农村合作心理健康干预中的护理质量提出的治疗建议。
Treatment recommendations made by a consultant psychiatrist to improve the quality of care in a collaborative mental health intervention in rural Nepal.
机构信息
Nyaya Health Nepal, Kathmandu, Nepal.
Departments of Global Health System Design and Global Health, Internal Medicine, and Pediatrics, Mount Sinai School of Medicine, New York, NY, USA.
出版信息
BMC Psychiatry. 2020 Feb 5;20(1):46. doi: 10.1186/s12888-020-2464-1.
BACKGROUND
The Collaborative Care Model (CoCM) for mental healthcare, where a consulting psychiatrist supports primary care and behavioral health workers, has the potential to address the large unmet burden of mental illness worldwide. A core component of this model is that the psychiatrist reviews treatment plans for a panel of patients and provides specific clinical recommendations to improve the quality of care. Very few studies have reported data on such recommendations. This study reviews and classifies the recommendations made by consulting psychiatrists in a rural primary care clinic in Nepal.
METHODS
A chart review was conducted for all patients whose cases were reviewed by the treatment team from January to June 2017, after CoCM had been operational for 6 months. Free text of the recommendations were extracted and two coders analyzed the data using an inductive approach to group and categorize recommendations until the coders achieved consensus. Cumulative frequency of the recommendations are tabulated and discussed in the context of an adapted CoCM in rural Nepal.
RESULTS
The clinical team discussed 1174 patient encounters (1162 unique patients) during panel reviews throughout the study period. The consultant psychiatrist made 214 recommendations for 192 (16%) patients. The most common recommendations were to revisit the primary mental health diagnosis (16%, n = 34), add or increase focus on counselling and psychosocial support (9%, n = 20), increase the antidepressant dose (9%, n = 20), and discontinue inappropriate medications (6%, n = 12).
CONCLUSIONS
In this CoCM study, the majority of treatment plans did not require significant change. The recommendations highlight the challenge that non-specialists face in making an accurate mental health diagnosis, the relative neglect of non-pharmacological interventions, and the risk of inappropriate medications. These results can inform interventions to better support non-specialists in rural areas.
背景
协作式医疗模式（CoCM）在精神卫生保健中，顾问精神科医生为初级保健和行为健康工作者提供支持，有可能解决全球范围内大量未满足的精神疾病负担。该模式的一个核心组成部分是，精神科医生审查一组患者的治疗计划，并提供具体的临床建议，以提高护理质量。很少有研究报告过此类建议的数据。本研究回顾并分类了尼泊尔农村初级保健诊所中顾问精神科医生提出的建议。
方法
对 2017 年 1 月至 6 月 CoCM 运行 6 个月后，由治疗团队审查的所有患者进行了图表审查。提取建议的自由文本，然后由两名编码员使用归纳方法分析数据，将建议分组和分类，直到编码员达成共识。列出建议的累积频率，并结合在尼泊尔农村地区适应性 CoCM 的背景下进行讨论。
结果
在整个研究期间，临床团队在小组审查中讨论了 1174 次患者就诊（1162 名独特患者）。顾问精神科医生为 192 名（16%）患者提出了 214 项建议。最常见的建议是重新审视主要精神卫生诊断（16%，n=34）、增加或加强心理咨询和心理社会支持（9%，n=20）、增加抗抑郁药剂量（9%，n=20）和停用不适当的药物（6%，n=12）。
结论
在这项 CoCM 研究中，大多数治疗计划不需要重大改变。这些建议突出了非专业人员准确进行精神卫生诊断的挑战、非药物干预相对忽视以及不适当药物的风险。这些结果可以为干预措施提供信息，以更好地支持农村地区的非专业人员。
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