背景:将心理健康纳入初级保健-即,在以前没有提供的现有多用途卫生保健环境中提供一系列基本精神卫生保健和服务的过程-可能会受到一些仍然知之甚少的卫生系统因素的促进或阻碍。这项研究旨在确定刚果民主共和国(DRC)将精神卫生服务纳入初级保健的卫生系统促进因素和障碍,以提高整合计划的成功率。
方法:我们采用了多种方法,横断面探索性研究。利益相关者(经理,卫生服务提供者,服务用户,等。)来自刚果民主共和国26个省中的16个省参加了会议。我们通过31个人收集了定性数据,半结构化,面对面的关键线人采访。然后,我们通过对413名受访者的基于人群的调查收集了定量数据。我们通过主题分析对访谈进行了分析,将逐字分配给预定义的主题和子主题。对于调查答复,我们进行了描述性分析,然后进行了二项逻辑回归,以探索感兴趣变量之间的关联.
结果:强有力的领导承诺,对精神卫生保健的积极态度,护理方案的可用性,心理健康任务共享(p<0.001),足够数量的初级保健提供者(PCP)(p<0.001)被确定为成功整合的关键卫生系统促进者.然而,整合的障碍主要与对什么是整合,什么不是整合的理解不足有关,以及卫生设施的功能和性能不佳。此外,污名,心理健康的低优先级,缺乏心理健康指标,训练有素的卫生专业人员的保留率低,缺乏报告工具,缺乏标准化的国家整合指南(p<0.001),缺乏资金(p<0.001),缺乏心理健康专家来指导PCP(p<0.001),缺乏精神药物(p<0.001)被认为是卫生系统整合的障碍。
结论:在整合精神保健之前改善初级保健设施的功能将有利于取得更大的成功。此外,解决已确定的障碍,例如缺乏资金和与心理健康相关的耻辱,需要在卫生系统的所有构建模块中采取多利益相关方行动。
BACKGROUND: The integration of mental health into primary care-i.e., the process by which a range of essential mental health care and services are made available in existing multipurpose health care settings that did not previously provide them-can be facilitated or hindered by several health system factors that are still poorly understood. This study aimed to identify health system facilitators and barriers to the integration of mental health services into primary care in the Democratic Republic of the Congo (DRC) to improve the success rate of integration programs.
METHODS: We conducted a multimethod, cross-sectional exploratory study. Stakeholders (managers, health service providers, service users, etc.) from sixteen of the twenty-six provinces of the DRC participated. We collected qualitative data through 31 individual, semistructured, face-to-face key informant interviews. We then collected quantitative data through a population-based survey of 413 respondents. We analyzed the interviews via thematic analysis, assigning verbatims to predefined themes and subthemes. For the survey responses, we performed descriptive analysis followed by binomial logistic regression to explore the associations between the variables of interest.
RESULTS: Strong leadership commitment, positive attitudes toward mental health care, the availability of care protocols, mental health task sharing (p < 0.001), and sufficient numbers of primary care providers (PCPs) (p < 0.001) were identified as key health system facilitators of successful integration. However, barriers to integration are mainly related to a poor understanding of what integration is and what it is not, as well as to the poor functionality and performance of health facilities. In addition, stigma, low prioritization of mental health, lack of mental health referents, low retention rate of trained health professionals, lack of reporting tools, lack of standardized national guidelines for integration (p < 0.001), lack of funding (p < 0.001), shortage of mental health specialists to coach PCPs (p < 0.001), and lack of psychotropic medications (p < 0.001) were identified as health system barriers to integration.
CONCLUSIONS: Improving the functionality of primary care settings before integrating mental health care would be beneficial for greater success. In addition, addressing identified barriers, such as lack of funding and mental health-related stigma, requires multistakeholder action across all building blocks of the health system.