Department of Psychiatry and Mental Health, Muhimbili University of Health and Allied Science, P.O Box 65001, United Nations Road, Dar Es Salaam, Tanzania.
Department of Psychiatry, School of Medicine, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia.
BMC Prim Care. 2023 Apr 21;24(1):106. doi: 10.1186/s12875-023-02061-1.
Integrating evidence-based interventions for people with alcohol use disorder (AUD) into primary healthcare (PHC) can increase access to care and reduce morbidity, mortality, and population burden. However, for the integration to be feasible, acceptable, and sustainable, there is a need to contextualize the approach and involve stakeholders. Therefore, this study aimed to use participatory methods to adapt a model for integrating AUD interventions in Tanzania's PHC system at the community, facility, and organizational levels.
A mixed-methods study was used. Participants include key mental health stakeholders, experts, and PHC providers. We conducted a situational analysis to investigate opportunities and constraints in the existing systems of care, utilizing data available from the routine collection and/or in the public domain, individual semi-structured interviews (n = 11), and focus group discussions (3 groups; total n = 26 participants) and a series of theory of change (ToC) workshops (n = 32). Data from the three methods were triangulated to develop the adapted model for integrating interventions for AUD in PHC.
A situational appraisal revealed limited community, facility, and organizational resources and infrastructures for supporting services delivery of integrated AUD interventions. Also, shortage of health workforce, inadequate health management information systems, and limited medical supply and financing. Nevertheless, the theory of change proposed integrated AUD intervention packages and strategies to facilitate integrated care for people with AUD. Additionally, the barriers and facilitators for implementing these integrated AUD interventions and how to overcome them were explored.
The adapted model for the integrated AUD intervention in Tanzanian PHC revealed limited resources and system functioning for facilitating integrated AUD services. Nevertheless, it proposes the needed integrated AUD interventions and its barriers, facilitators, and strategies for overcoming them. There is a need to pilot the adapted model to inform plans for more comprehensive implementation or scaling up.
将针对酒精使用障碍（AUD）患者的循证干预措施整合到基层医疗保健（PHC）中，可以增加获得护理的机会，并降低发病率、死亡率和人口负担。然而，为了使整合具有可行性、可接受性和可持续性，需要对方法进行调整并让利益相关者参与进来。因此，本研究旨在使用参与式方法来调整一个模型，以便在坦桑尼亚的 PHC 系统中在社区、设施和组织层面整合 AUD 干预措施。
本研究采用混合方法。参与者包括主要的心理健康利益相关者、专家和 PHC 提供者。我们进行了一项情况分析，以调查现有护理系统中的机会和制约因素，利用现有常规收集和/或公共领域的数据、个人半结构化访谈（n=11）和焦点小组讨论（3 组；总参与者 26 人）以及一系列变革理论（ToC）研讨会（n=32）。三种方法的数据进行了三角剖分，以开发适用于 PHC 中 AUD 干预措施整合的调整模型。
情况评估显示，支持提供综合 AUD 干预服务的社区、设施和组织资源和基础设施有限。此外，卫生人力短缺、卫生管理信息系统不足、医疗供应和资金有限。然而，变革理论提出了综合 AUD 干预包和策略，以促进 AUD 患者的综合护理。此外，还探讨了实施这些综合 AUD 干预措施的障碍和促进因素，以及如何克服这些障碍和促进因素。
坦桑尼亚 PHC 中综合 AUD 干预的调整模型显示，促进综合 AUD 服务的资源和系统功能有限。然而，它提出了需要的综合 AUD 干预措施及其障碍、促进因素和克服障碍的策略。需要试点调整后的模型，以便为更全面的实施或扩大规模提供计划。
