Sarakbi Diana, Groll Dianne, Tranmer Joan, Kessler Rodger, Sears Kim
Health Quality Programs, Queen's University, Ontario, Canada.
Department of Psychiatry and Psychology, Queen's University, Ontario, Canada.
Int J Integr Care. 2024 Feb 1;24(1):6. doi: 10.5334/ijic.7685. eCollection 2024 Jan-Mar.
Quality integrated care, which involves primary care and mental health clinicians working together, can help identify and treat adolescent depression early. We explored systemic barriers to quality integrated care at the provincial level in Ontario, Canada using a learning system approach.
Two Ontario Health Teams (OHTs), regional networks designed to support integrated care, completed the Practice Integration Profile (PIP) and participated in focus groups.
The OHTs had a median PIP score of 69 out of 100. Among the PIP domains, the lowest median score was case identification (50), and the highest one was workspace (100). The focus groups generated 180 statements mapped to the PIP domains. Workflow had the highest number of coded statements (59, 32.8%).
While the primary care practices included mental health clinicians on-site, the findings highlighted systemic barriers with adhering to the integrated care pathway for adolescent depression. These include limited access to mental health expertise for assessment and diagnosis, long wait times for treatment, and shortages of clinicians trained in evidence-based behavioral therapies. These challenges contributed to the reliance on antidepressants as the first line of treatment due to their accessibility rather than evidence-based guidelines.
Primary care practices, within regional networks such as OHTs, can form learning systems to continuously identify the strategies needed to support quality integrated care for adolescent depression based on real-world data.
优质综合护理涉及初级护理和心理健康临床医生共同协作，有助于早期识别和治疗青少年抑郁症。我们采用学习系统方法，在加拿大安大略省省级层面探索了优质综合护理的系统性障碍。
两个安大略省健康团队（OHTs），即旨在支持综合护理的区域网络，完成了实践整合概况（PIP）并参与了焦点小组。
OHTs的PIP中位数得分为69分（满分100分）。在PIP各领域中，中位数得分最低的是病例识别（50分），最高的是工作空间（100分）。焦点小组产生了180条映射到PIP各领域的陈述。工作流程的编码陈述数量最多（59条，占32.8%）。
虽然初级护理机构配备了心理健康临床医生，但研究结果突出了在遵循青少年抑郁症综合护理路径方面存在的系统性障碍。这些障碍包括获得心理健康专业知识进行评估和诊断的机会有限、治疗等待时间长以及缺乏接受循证行为疗法培训的临床医生。由于抗抑郁药容易获取而非基于循证指南，这些挑战导致了对其作为一线治疗方法的依赖。
在OHTs等区域网络内的初级护理机构可以形成学习系统，根据实际数据持续确定支持青少年抑郁症优质综合护理所需的策略。
