在初级保健中使用DIALOG+改善慢性病患者生活质量和精神困扰的可行性、经验及结果：波斯尼亚和黑塞哥维那、哥伦比亚及乌干达的一项探索性非对照试验
Feasibility, experiences and outcomes of using DIALOG+ in primary care to improve quality of life and mental distress of patients with chronic conditions: an exploratory non-controlled trial in Bosnia and Herzegovina, Colombia and Uganda.
作者信息
van Loggerenberg Francois, McGrath Michael, Akena Dickens, Birabwa-Oketcho Harriet, Méndez Camilo Andrés Cabarique, Gómez-Restrepo Carlos, Džubur Kulenoviĉ Alma, Muhić Maja, Sewankambo Nelson K, Sikira Hana, Priebe Stefan
机构信息
Unit for Social and Community Psychiatry, Queen Mary University of London, London, UK.
Department of Psychiatry, Makerere University College of Health Sciences, Kampala, Uganda.
出版信息
Pilot Feasibility Stud. 2021 Sep 30;7(1):180. doi: 10.1186/s40814-021-00914-z.
BACKGROUND
DIALOG+ is a resource-oriented and evidence-based intervention to improve quality of life and reduce mental distress. While it has been extensively studied in mental health care, there is little evidence for how to use it in primary care settings for patients with chronic physical conditions. Considering that DIALOG+ is used in existing routine patient-clinician meetings and is very low cost, it may have the potential to help large numbers of patients with chronic physical conditions, mental distress and poor quality of life who are treated in primary care. This is particularly relevant in low- and middle-income countries (LMICs) where resources for specialised services for such patients are scarce or non-existent.
METHODS
An exploratory non-controlled trial will be conducted to primarily assess the feasibility and acceptability and, secondarily, outcomes of delivering DIALOG+ to patients with chronic physical conditions and poor quality of life in primary care settings in Bosnia and Herzegovina, Colombia and Uganda. Thirty patients in each country will receive DIALOG+ up to three times in monthly meetings over a 3-month period. Feasibility will be assessed by determining the extent to which the intervention is implemented as planned. Experiences will be captured in interviews and focus groups with care providers and participants to understand acceptability. Quality of life, symptoms of anxiety and depression, objective social situation and health status will be assessed at baseline and again after the three-session intervention.
DISCUSSION
This study will inform our understanding of the extent to which DIALOG+ may be used in the routine care of patients with chronic physical conditions in different primary care settings. The findings of this exploratory trial can inform the design of future full randomised controlled trials of DIALOG+ in primary care settings in LMICs.
TRIAL REGISTRATION
All studies were registered prospectively (on 02/12/2020 for Uganda and Bosnia and Herzegovina, and 01/12/2020 for Colombia) within the ISRCTN Registry. ISRCTN17003451 (Bosnia and Herzegovina), ISRCTN14018729 (Colombia) and ISRCTN50335796 (Uganda). Protocol version and date: v2.0; 28/07/2020 (Bosnia and Herzegovina), v0.3 02/08/2020 (Colombia) and v1.0, 05/11/2020 (Uganda).
背景
DIALOG+是一种以资源为导向、基于证据的干预措施，旨在改善生活质量并减轻精神困扰。虽然它在精神卫生保健领域已得到广泛研究，但在初级保健环境中如何将其应用于患有慢性身体疾病的患者，相关证据却很少。鉴于DIALOG+可用于现有的常规医患会面且成本极低，它可能有潜力帮助大量在初级保健机构接受治疗的患有慢性身体疾病、精神困扰且生活质量较差的患者。这在低收入和中等收入国家（LMICs）尤为重要，因为为这类患者提供专科服务的资源稀缺或根本不存在。
方法
将开展一项探索性非对照试验，主要评估可行性和可接受性，其次评估在波斯尼亚和黑塞哥维那、哥伦比亚及乌干达的初级保健环境中，向患有慢性身体疾病和生活质量较差的患者提供DIALOG+的效果。每个国家的30名患者将在为期3个月的时间里，每月最多参加3次会议以接受DIALOG+。将通过确定干预措施按计划实施的程度来评估可行性。将通过与护理人员和参与者进行访谈及焦点小组讨论来了解他们的体验，以评估可接受性。将在基线时以及在进行三次干预后再次评估生活质量、焦虑和抑郁症状、客观社会状况及健康状况。
讨论
本研究将增进我们对DIALOG+在不同初级保健环境中用于慢性身体疾病患者常规护理的程度的理解。这项探索性试验的结果可为未来在低收入和中等收入国家初级保健环境中开展的DIALOG+全随机对照试验的设计提供参考。
试验注册
所有研究均已前瞻性注册（乌干达和波斯尼亚和黑塞哥维那于2020年12月2日注册，哥伦比亚于2020年12月1日注册），登记号为ISRCTN。ISRCTN17003451（波斯尼亚和黑塞哥维那）、ISRCTN14018729（哥伦比亚）和ISRCTN50335796（乌干达）。方案版本和日期：v2.0；2020年7月28日（波斯尼亚和黑塞哥维那）、v0.3 2020年8月2日（哥伦比亚）和v1.0，2020年11月5日（乌干达）。
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