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Optimizing treatment cascades for mental healthcare in Mozambique: preliminary effectiveness of the Systems Analysis and Improvement Approach for Mental Health (SAIA-MH).
Fabian, Katrin E; Muanido, Alberto; Cumbe, Vasco F J; Manaca, Nelia; Hicks, Leecreesha; Weiner, Bryan J; Sherr, Kenneth; Wagenaar, Bradley H.
Afiliação
  • Fabian KE; Department of Global Health, University of Washington, Seattle, WA, USA.
  • Muanido A; Health Alliance International, Beira, Mozambique.
  • Cumbe VFJ; Sofala Provincial Health Directorate, Department of Mental Health, Ministry of Health, Beira, Mozambique.
  • Manaca N; Faculty of Medicine, Eduardo Mondlane University, Mozambique.
  • Hicks L; Health Alliance International, Beira, Mozambique.
  • Weiner BJ; Health Alliance International, Seattle, WA, USA.
  • Sherr K; Department of Global Health, University of Washington, Seattle, WA, USA.
  • Wagenaar BH; Department of Health Services, University of Washington, Seattle, WA, USA.
Health Policy Plan ; 35(10): 1354-1363, 2021 Feb 16.
Article em En | MEDLINE | ID: mdl-33221835
Substantial investments are being made to scale-up access to mental healthcare in low- and middle-income countries, but less attention has been paid to quality and performance of nascent public-sector mental healthcare systems. This study tested the initial effectiveness of an implementation strategy to optimize routine outpatient mental healthcare cascade performance in Mozambique [the Systems Analysis and Improvement Approach for Mental Health (SAIA-MH)]. This study employed a pre-post design from September 2018 to August 2019 across four Ministry of Health clinics among 810 patients and 3234 outpatient mental health visits. Effectiveness outcomes evaluated progression through the care cascade, including: (1) initial diagnosis and medication selection; (2) enrolling in follow-up care; (3) returning after initial consultation within 60 days; (4) returning for follow-up visits on time; (5) returning for follow-up visits adherent to medication and (6) achieving function improvement. Clustered generalized linear models evaluated odds of completing cascade steps pre- vs post-intervention. Facilities prioritized improvements focused on the follow-up cascade, with 62.5% (10 of 16) monthly system modifications targeting medication adherence. At baseline, only 4.2% of patient visits achieved function improvement; during the 6 months of SAIA-MH implementation, this improved to 13.1% of patient visits. Multilevel logistic regression found increased odds of returning on time and adherent [aOR = 1.53, 95% CI (1.21, 1.94), P = 0.0004] and returning on time, adherent and with function improvement [aOR = 3.68, 95% CI (2.57, 5.44), P < 0.0001] after SAIA-MH implementation. No significant differences were observed regarding other cascade steps. The SAIA-MH implementation strategy shows promise for rapidly and significantly improving mental healthcare cascade outcomes, including the ultimate goal of patient function improvement. Given poor baseline mental healthcare cascade performance, there is an urgent need for evidence-based implementation strategies to optimize the performance of mental healthcare cascades in low- and middle-income countries.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Saúde Mental / Serviços de Saúde Mental Tipo de estudo: Evaluation_studies Limite: Humans País/Região como assunto: Africa Idioma: En Revista: Health Policy Plan Assunto da revista: PESQUISA EM SERVICOS DE SAUDE / SAUDE PUBLICA Ano de publicação: 2021 Tipo de documento: Article País de afiliação: Estados Unidos

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Saúde Mental / Serviços de Saúde Mental Tipo de estudo: Evaluation_studies Limite: Humans País/Região como assunto: Africa Idioma: En Revista: Health Policy Plan Assunto da revista: PESQUISA EM SERVICOS DE SAUDE / SAUDE PUBLICA Ano de publicação: 2021 Tipo de documento: Article País de afiliação: Estados Unidos