scholarly journals Evaluating the delivery of Problem Management Plus in primary care settings in rural Rwanda: a study protocol using a pragmatic randomised hybrid type 1 effectiveness-implementation design

BMJ Open ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. e054630
Author(s):  
Stephanie L Smith ◽  
Beatha Nyirandagijimana ◽  
Janvier Hakizimana ◽  
Roger P Levy ◽  
Robert Bienvenu ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Health Systems ◽  
Psychological Interventions ◽  
Problem Management ◽  
Low Intensity ◽  
Primary Care Settings ◽  
Primary Care Nurses ◽  
Health Centres

IntroductionEvidence-based low-intensity psychological interventions such as Problem Management Plus (PM+) have the potential to expand treatment access for depression and anxiety, yet these interventions are not yet effectively implemented in rural, public health systems in resource-limited settings. In 2017, Partners In Health adapted PM+ for delivery by primary care nurses in rural Rwanda and began integrating PM+ into health centres in collaboration with the Rwandan Ministry of Health, using established implementation strategies for mental health integration into primary care (Mentoring and Enhanced Supervision at Health Centers for Mental Health (MESH MH)). A gap in the evidence regarding whether low-intensity psychological interventions can be successfully integrated into real-world primary care settings and improve outcomes for common mental disorders remains. In this study, we will rigorously evaluate the delivery of PM+ by primary care nurses, supported by MESH MH, as it is scaled across one rural district in Rwanda.Methods and analysisWe will conduct a hybrid type 1 effectiveness-implementation study to test the clinical outcomes of routinely delivered PM+ and to describe the implementation of PM+ at health centres. To study the clinical effectiveness of PM+, we will use a pragmatic, randomised multiple baseline design to determine whether participants experience improvement in depression symptoms (measured by the Patient Health Questionnaire-9) and functioning (measured by the WHO-Disability Assessment Scale Brief 2.0) after receiving PM+. We will employ quantitative and qualitative methods to describe and evaluate PM+ implementation outcomes using the Reach, Effectiveness, Adoption, Implementation and Maintenance framework, using routinely collected programme data and semistructured interviews.Ethics and disseminationThis evaluation was approved by the Rwanda National Ethics Committee (Protocol #196/RNEC/2019) and deemed exempt by the Harvard University Institutional Review Board. The results from this evaluation will be useful for health systems planners and policy-makers working to translate the evidence base for low-intensity psychological interventions into practice.

Maori adaptation of a low intensity mental health intervention in primary care

2012 ◽  
Author(s):  
Fiona Mathieson ◽  
Kara Mihaere ◽  
Sunny Collings ◽  
Anthony Dowell ◽  
James Stanley
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Health Intervention ◽  
Mental Health Intervention ◽  
Low Intensity

1265-P: The Paradox of Care Delivery for Type 1 Diabetes in Primary Care Settings: A Call for Interventions to Reduce Health Disparities

Diabetes ◽  
2019 ◽  
Vol 68 (Supplement 1) ◽  
pp. 1265-P ◽  
Author(s):  
ASHBY F. WALKER ◽  
NICOLAS CUTTRISS ◽  
MICHAEL J. HALLER ◽  
KATARINA YABUT ◽  
CLAUDIA ANEZ-ZABALA ◽  
...  
Keyword(s):  
Primary Care ◽  
Type 1 Diabetes ◽  
Health Disparities ◽  
Care Delivery ◽  
Primary Care Settings

scholarly journals Evaluating the implementation of a primary care intervention to reduce prescriptions of benzodiazepines (BENZORED IV)

2021 ◽  
Author(s):  
Isabel Socias ◽  
Alfonso Leiva ◽  
Haizea Pombo-Ramos ◽  
Ferran Bejarano ◽  
Ermengol Sempere-Verdú ◽  
...  
Keyword(s):  
Primary Care ◽  
Traffic Accidents ◽  
Implementation Strategies ◽  
Developed Countries ◽  
Successful Implementation ◽  
Implementation Climate ◽  
Primary Care Settings ◽  
The Individual

Abstract Background: General practitioners (GPs) in developed countries widely prescribe benzodiazepines (BZDs) for their anxiolytic, hypnotic, and muscle-relaxant effects. Treatment duration, however, is rarely limited and this results in a significant number of chronic users. Long-term BZD use is associated with cognitive impairment, falls with hip fractures, traffic accidents, and increased mortality. The BENZORED IV trial was a hybrid type 1 trial conducted to evaluate the effectiveness and implementation of an intervention to reduce BZD prescription in primary care. The purpose of this qualitative study was to analyze facilitator and barriers to implement the intervention to primary care settings.Methods: Focus group meetings with GPs from the intervention arm of the BENZORED IV trial were held at primary healthcare centers in the three districts. For sampling purposes, the GPs were classified as high or low implementers according to the success of the intervention measured at 12 months. The Consolidated Framework for Implementation Research (CFIR) was used to conduct the meetings and to code, rate and analyze the dataResults: Three of the 41 CFIR constructs strongly distinguished between high and low implementers: The complexity in the intervention, the individual Stage of Change and the key stakeholder’s engagement. Seven constructs weakly discriminated between the two groups: the adaptability in the intervention, the external policy and incentives, the implementation climate, the relative priority, the self-efficacy and formally appointed implementation leader engaging. Fourteen constructs did not discriminate between the two groups, six had insufficient data for evaluation, and eleven had no data for evaluation.Conclusion: We identified constructs that could explain the variation in the implementation of the intervention, this information is relevant to design successful implementation strategies to implement the intervention.

Problem solving in type 1 diabetes for primary care nurses–part 2

2019 ◽  
Vol 2019 (12) ◽  
pp. 25-28
Author(s):  
David Morris
Keyword(s):  
Primary Care ◽  
Type 1 Diabetes ◽  
Problem Solving ◽  
Primary Care Nurses

In the second part of this series, David Morris answers more questions around treating patients with T1DM

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