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哥伦比亚初级保健中抑郁诊断和治疗的障碍和促进因素:提供者、医疗保健管理人员、患者和社区代表的观点。

Barriers and facilitators to the diagnosis and treatment of depression in primary care in Colombia: Perspectives of providers, healthcare administrators, patients and community representatives.

机构信息

Center for Technology and Behavioral Health, Geisel School of Medicine, Dartmouth College, Lebanon, NH, USA.

Departamento de Epidemiología y Bioestadística, Facultad de Medicina, Pontificia Universidad Javeriana, Bogotá, Colombia.

出版信息

Rev Colomb Psiquiatr (Engl Ed). 2021 Jul;50 Suppl 1(Suppl 1):64-72. doi: 10.1016/j.rcpeng.2021.01.001. Epub 2021 Jul 17.

Abstract

INTRODUCTION

Depression represents a major disease burden in Colombia. To better understand opportunities to improve access to mental healthcare in Colombia, a research team at Javeriana University conducted formative qualitative research to explore stakeholders' experiences with the integration of mental healthcare into the primary care system.

METHODS

The research team conducted 16 focus groups and 4 in-depth interviews with patients, providers, health administrators and representatives of community organisations at five primary care clinics in Colombia, and used thematic analysis to study the data.

RESULTS

Themes were organised into barriers and facilitators at the level of patients, providers, organisations and facilities. Barriers to the treatment of depression included stigma, lack of mental health literacy at the patient and provider level, weak links between care levels, and continued need for mental health prioritization at the national level. Facilitators to the management of depression in primary care included patient support systems, strong patient-provider relationships, the targeting of depression interventions and national depression guidelines.

DISCUSSION

This study elucidates the barriers to depression care in Colombia, and highlights action items for further integrating depression care into the primary care setting.

摘要

简介

在哥伦比亚,抑郁症是一个主要的疾病负担。为了更好地了解改善哥伦比亚精神卫生保健服务获取途径的机会,哈韦里亚纳大学的一个研究团队开展了形成性定性研究,以探索利益相关者在将精神卫生保健纳入初级保健系统方面的经验。

方法

研究团队在哥伦比亚的五家初级保健诊所进行了 16 次焦点小组和 4 次深度访谈,参与者包括患者、医务人员、卫生行政人员和社区组织代表,并使用主题分析方法对数据进行研究。

结果

主题分为患者、提供者、组织和医疗机构层面的障碍和促进因素。治疗抑郁症的障碍包括污名化、患者和提供者的心理健康素养缺乏、护理水平之间的联系薄弱,以及在国家层面继续需要精神卫生优先事项。在初级保健中管理抑郁症的促进因素包括患者支持系统、医患关系牢固、有针对性的抑郁干预措施和国家抑郁指南。

讨论

本研究阐明了哥伦比亚抑郁症治疗方面的障碍,并强调了进一步将抑郁症治疗纳入初级保健的行动要点。

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