Center for Behavioral Intervention Technologies, Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Merck & Co., Inc, Boston, MA, USA.
Prim Health Care Res Dev. 2022 Aug 31;23:e51. doi: 10.1017/S146342362200038X.
To identify implementation strategies for collaborative care (CC) that are successful in the context of perinatal care.
Perinatal depression is one of the most common complications of pregnancy and is associated with adverse maternal, obstetric, and neonatal outcomes. Although treating depressive symptoms reduces risks to mom and baby, barriers to accessing psychiatric treatment remain. CC has demonstrated benefit in primary care, expanding access, yet few studies have examined the implementation of CC in perinatal care which presents unique characteristics and challenges.
We conducted qualitative interviews with 20 patients and 10 stakeholders from Collaborative Care Model for Perinatal Depression Support Services (COMPASS), a perinatal collaborative care (pCC) program implemented since 2017. We analyzed interview data by employing the Exploration, Preparation, Implementation, Sustainment (EPIS) framework to organize empirically selected implementation strategies from Expert Recommendations for Implementing Change (ERIC) to create a guide for the development of pCC programs.
We identified 14 implementation strategies used in the implementation of COMPASS. Strategies were varied, cutting across ERIC domains (eg, plan, educate, finance) and across EPIS contexts (eg, inner context - characteristics of the pCC program). The majority of strategies were identified by patients and staff as facilitators of pCC implementation. In addition, findings show opportunities for improving the implementation strategies used, such as optimal dissemination of educational materials for obstetric clinicians. The implementation of COMPASS can serve as a model for the process of building a pCC program. The identified strategies can support the implementation of this evidence-based practice for addressing postpartum depression.
确定在围产期护理背景下成功实施协作式护理（CC）的实施策略。
围产期抑郁症是妊娠最常见的并发症之一，与产妇、产科和新生儿不良结局相关。尽管治疗抑郁症状可以降低母婴风险，但获得精神治疗的障碍仍然存在。CC 在初级保健中已证明具有益处，可以扩大服务范围，但很少有研究检查 CC 在围产期护理中的实施情况，因为后者具有独特的特点和挑战。
我们对 20 名患者和 COMPASS（围产期抑郁支持服务协作护理模型）的 10 名利益相关者进行了定性访谈，该项目自 2017 年以来一直在实施围产期协作护理（pCC）计划。我们采用探索、准备、实施、维持（EPIS）框架分析访谈数据，从专家推荐实施变革（ERIC）中选择经验证的实施策略，为 pCC 计划的制定创建一个指南。
我们确定了在 COMPASS 实施过程中使用的 14 项实施策略。这些策略多种多样，跨越 ERIC 领域（例如，计划、教育、财务）和 EPIS 背景（例如，内部环境- pCC 计划的特征）。大多数策略都被患者和工作人员认为是促进 pCC 实施的因素。此外，研究结果还显示了改进所使用实施策略的机会，例如为产科临床医生优化教育材料的传播。COMPASS 的实施可以作为建立 pCC 项目的过程模型。确定的策略可以支持实施这一基于证据的实践，以解决产后抑郁症。
