Dabholkar Hamid, Pillai Aravind, Gaonkar Dilip, Deuri Sonia Pereira, Naik Smita, Chatterjee Sudipto
Parivartan Trust, Satara, Maharashtra, India.
Parivartan Trust, Tezpur, Assam, India.
Implement Res Pract. 2023 May 22;4:26334895231175528. doi: 10.1177/26334895231175528. eCollection 2023 Jan-Dec.
There is a priority need to make community-based care widely available for people living with schizophrenia (PLwS) in low- and middle-income countries. An innovative approach for increasing access could be to integrate clinical services available in tertiary care hospitals with community-based care through a task-sharing approach. We describe such an integrated intervention that was implemented at Tezpur in northeast India in collaboration with the Lokopriya Gopinath Bordoloi Regional Institute of Mental Health (LGBRIMH).
The objectives of the study were to illustrate the feasibility of integrating and implementing the intervention and to describe its individual, systemic, and public health impacts. Due to the limited resources available, we conducted a pragmatic single-arm longitudinal evaluation of the intervention cohort over 24 months.
Of the 239 PLwS enrolled in the intervention, 198 (83%) were followed up for 24 months, with nearly three-quarters reporting a >70% reduction in disabilities, most notably between 6 and 18 months. There was a marked reduction in unmet needs across multiple domains, and at 24 months, 62% of the cohort was engaged in individual jobs or other market-linked livelihood opportunities. There was greater uptake and retention with outpatient contacts at the LGBRIMH, and PLwS experienced a marked (82%) reduction in inpatient admissions rates, as compared to before enrolment. Over a period of 24 months, primary caregivers reported that their families experienced significantly fewer social difficulties such as unemployment, interpersonal conflicts, and social isolation. The intervention had a significant public health impact, with an estimated 51.8% effective treatment coverage rate for the integrated intervention.
Our findings provide preliminary evidence of the feasibility of implementing the integrated intervention and its effectiveness. We believe that there is merit in further in-depth refinement and exploration of this implementation-related research and cost analysis while replicating the intervention in other tertiary care institutions.
在低收入和中等收入国家，为精神分裂症患者（PLwS）广泛提供基于社区的护理迫在眉睫。一种增加可及性的创新方法可能是通过任务分担的方式，将三级护理医院提供的临床服务与基于社区的护理相结合。我们描述了一种在印度东北部的提斯浦尔与洛科普里亚·戈皮纳特·博多洛伊地区精神卫生研究所（LGBRIMH）合作实施的综合干预措施。
该研究的目的是说明整合和实施该干预措施的可行性，并描述其对个人、系统和公共卫生的影响。由于可用资源有限，我们对干预队列进行了为期24个月的务实单臂纵向评估。
在参与干预的239名精神分裂症患者中，198名（83%）接受了24个月的随访，近四分之三的患者报告残疾减少了70%以上，最明显的是在6至18个月之间。多个领域未满足的需求显著减少，在24个月时，62%的队列成员从事个体工作或其他与市场相关的生计机会。LGBRIMH的门诊就诊量和留存率更高，与入组前相比，精神分裂症患者的住院率显著降低（82%）。在24个月的时间里，主要照顾者报告说，他们的家庭经历的社会困难显著减少，如失业、人际冲突和社会孤立。该干预措施对公共卫生产生了重大影响，综合干预措施的有效治疗覆盖率估计为51.8%。
我们的研究结果为实施综合干预措施的可行性及其有效性提供了初步证据。我们认为，在其他三级护理机构复制该干预措施的同时，进一步深入完善和探索这项与实施相关的研究和成本分析是有价值的。
