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BMJ ; 365: l835, 2019 Apr 08.
Artigo em Inglês | MEDLINE | ID: mdl-30962249


Depression is a common and heterogeneous condition with a chronic and recurrent natural course that is frequently seen in the primary care setting. Primary care providers play a central role in managing depression and concurrent physical comorbidities, and they face challenges in diagnosing and treating the condition. In this two part series, we review the evidence available to help to guide primary care providers and practices to recognize and manage depression. The first review outlined an approach to screening and diagnosing depression in primary care. This second review presents an evidence based approach to the treatment of depression in primary care, detailing the recommended lifestyle, drug, and psychological interventions at the individual level. It also highlights strategies that are being adopted at an organizational level to manage depression more effectively in primary care.

Depressão , Transtorno Depressivo , Humanos , Programas de Rastreamento , Atenção Primária à Saúde
Reprod Health ; 15(1): 131, 2018 Jul 27.
Artigo em Inglês | MEDLINE | ID: mdl-30053820


While much progress has been achieved globally in the fight against malaria, the significant financial investments made to date have not translated into scaled-up malaria in pregnancy (MiP) prevention efforts. Mothers and newborns remain at risk, and now is the time to refocus efforts. Against the backdrop of a new global health architecture embodied by the principles of Every Women, Every Child and driven by the work of the H6 Partnership, Global Financing Facility, strong bilaterals and key financiers, there is a new and timely juncture to advocate for MiP. Recent updates in the WHO Recommendations on Antenatal Care for a Positive Pregnancy Experience present an opportunity to strengthen MiP as a core maternal and child health issue and position MiP prevention as a priority.

Malária/prevenção & controle , Complicações Parasitárias na Gravidez/prevenção & controle , Criança , Feminino , Humanos , Recém-Nascido , Gravidez , Cuidado Pré-Natal
Int J Qual Health Care ; 29(4): 557-563, 2017 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-28651345


Objective: Integrated healthcare models can increase access to care, improve healthcare quality, and reduce cost for individuals with behavioral and general medical healthcare needs, yet there are few instruments for measuring the quality of integrated care. In this study, we identified and prioritized concepts that can represent the quality of integrated behavioral health and general medical care. Design: We conducted a literature review to identify candidate measure concepts. Experts then participated in a modified Delphi process to prioritize the concepts for development into specific quality measures. Setting: United States. Participants: Expert behavioral health and general medical clinicians, decision-makers (policy, regulatory and administrative professionals) and patient advocates. Main outcome measures: Panelists rated measure concepts on importance, validity and feasibility. Results: The literature review identified 734 measures of behavioral or general medical care, which were then distilled into 43 measure concepts. Thirty-three measure concepts (including a segmentation strategy) reached a predetermined consensus threshold of importance, while 11 concepts did not. Two measure concepts were 'ready for further development' ('General medical screening and follow-up in behavioral health settings' and 'Mental health screening at general medical healthcare settings'). Among the 31 additional measure concepts that were rated as important, 7 were rated as valid (but not feasible), while the remaining 24 concepts were rated as neither valid nor feasible. Conclusions: This study identified quality measure concepts that capture important aspects of integrated care. Researchers can use the prioritization process described in this study to guide healthcare quality measures development work.

Serviços de Saúde Mental/normas , Indicadores de Qualidade em Assistência à Saúde/normas , Prestação Integrada de Cuidados de Saúde , Técnica Delfos , Humanos , Avaliação de Processos e Resultados (Cuidados de Saúde) , Qualidade da Assistência à Saúde/normas , Estados Unidos