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拉丁美洲初级保健和社区环境中常见精神疾病的综合项目:对组成部分和实施策略的范围审查

Integrated programs for common mental illnesses within primary care and community settings in Latin America: a scoping review of components and implementation strategies.

作者信息

Paniagua-Avila Alejandra, Branas Charles, Susser Ezra, Fort Meredith P, Shelton Rachel, Trigueros Lourdes, Camara Barbara, Costigan Elen, Demis Lina, Florence Ana, Flores Maria, Miller-Suchet Lucy, Paredes-Montero Angela, Rodrigues Mariana, Kane Jeremy

机构信息

Department of Epidemiology, Mailman School of Public Health, Columbia University, New York City, NY, USA.

Asociación para la Salud Mental FUNDAMENTAL, Guatemala City, Guatemala.

出版信息

Lancet Reg Health Am. 2024 Dec 7;41:100931. doi: 10.1016/j.lana.2024.100931. eCollection 2025 Jan.

Abstract

Integrated programs for common mental illnesses are evidence-informed practices yet to be routinely implemented in Latin America. It synthesizes the literature on integrated programs for common mental illnesses (anxiety, depression, and posttraumatic stress disorder) in Latin American primary care and community settings. It maps program components (the 'what') to the collaborative care model core components and implementation strategies (the 'how') to the Expert Recommendations for Implementing Change (ERIC) taxonomy. Results from 18 programs across six countries (Belize, Brazil, Chile, Colombia, Mexico, Peru) show wide heterogeneity in component and strategy combinations. Overall, provider-level components and strategies were more common than family- or community-level ones. 'Team-based care' was the most commonly reported component, and 'family/user engagement' the least. The most common implementation strategy was 'supporting clinicians,' while 'changing infrastructure' was the least. Programs commonly addressed depression and only four followed experimental designs. We found limited evidence on the potential mechanisms of integrated program components and strategies.

摘要

常见精神疾病综合项目是基于证据的实践,但在拉丁美洲尚未得到常规实施。它综合了拉丁美洲初级保健和社区环境中常见精神疾病(焦虑症、抑郁症和创伤后应激障碍)综合项目的文献。它将项目组成部分(“是什么”)映射到协作护理模式的核心组成部分,并将实施策略(“如何做”)映射到实施变革专家建议(ERIC)分类法。来自六个国家(伯利兹、巴西、智利、哥伦比亚、墨西哥、秘鲁)的18个项目的结果显示,组成部分和策略组合存在很大差异。总体而言,提供者层面的组成部分和策略比家庭或社区层面的更为常见。“团队式护理”是最常报告的组成部分,而“家庭/用户参与”最少。最常见的实施策略是“支持临床医生”,而“改变基础设施”最少。项目通常涉及抑郁症,只有四个采用了实验设计。我们发现关于综合项目组成部分和策略潜在机制的证据有限。

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