Clinical trial NCT02376062: Bundled Intervention Integrating Mental Health Services in Nepal
Official title: Bundled Intervention Integrating Mental Health Service Into Rural Primary Care in Nepal: Implementation Research Study
Study type: INTERVENTIONAL
Overall status: UNKNOWN
Phase: NA
Conditions: Mental Health
Keywords: Continuing Medical Education
Chronic Diseases
Nepal
Implementation Research
Lead sponsor: Possible
Sponsor class: OTHER
Collaborators: name: University of California, San Francisco
name: Harvard Medical School Center for Global Health Delivery-Dubai
name: National Institute of Mental Health (NIMH)
name: Brigham and Women's Hospital
First posted: 2015-03-03
Enrollment: 225
Sex: ALL
Minimum age (years): 15
Standard ages: CHILD
ADULT
OLDER_ADULT
Accepts healthy volunteers: yes
Allocation: NA
Intervention model: SINGLE_GROUP
Primary purpose: HEALTH_SERVICES_RESEARCH

Brief summary: Globally, access to mental healthcare is often non-existent in rural, resource-deprived communities despite the pervasive need for services, particularly in post-conflict and post-disaster settings. We are developing and piloting will develop and pilot a culturally appropriate training model for non-specialist providers (NSPs) to deliver high-quality mental health care over a period of 24 months in a primary care hospital in a rural district in Nepal. We will employ a mixed methods framework to evaluate change in skills, knowledge, and attitude in NSP's, identify key mechanisms for continuum of mental healthcare delivery, and efficacy and cost-effectiveness in care delivery through a government hospital, clinics, and a network of community health workers. This integrated approach will introduce a bundled intervention that includes: both an on-site care coordinator and off-site psychiatric supervisors based in Nepal's capital, Kathmandu, weekly case conferences, and surveys of NSP's and clinical supervisors every six months during the study period. To learn about the acceptability, feasibility and challenges in the program we will also conduct Focus Group Discussions among the PCPs. In the last one year of the research in Achham District we have seen increase in knowledge efficacy and skills among the NSPs and also improved mental health care services at Bayalpata Hospital. Our experience in Achham motivated us to develop a similar program for Charikot Primary Health Center in Dolakha District. Outcomes of this study will focus on efficacy of this model to appropriately identify, counsel, and treat patients with depression, psychosis, and post-traumatic stress disorder (PTSD) through an integrated rural mental healthcare delivery intervention as a model for rural healthcare delivery.


Eligibility criteria: Inclusion Criteria:

* Primary Care Provider (MBBS-level physician or Health Assistant)
* Current staff at healthcare facility in Achham, Bajura, or Doti Districts.

Exclusion Criteria:

* N/A

Primary outcomes:
measure: Changes in knowledge, attitudes, practices, and self-efficacy of Primary Care Providers
timeFrame: 3 years
measure: Longitudinal clinical outcomes for patients with depression, post-traumatic stress disorder, and patient self-reported medication adherence
timeFrame: 3 years
measure: Cost assessment of bundled intervention
timeFrame: 3 years
Secondary outcomes:
Other outcomes:
Locations:
city: Sanfebagar
country: Nepal
facility: Bayalpata Hospital
state: Achham
city: Bhimeshwor
country: Nepal
facility: Charikot Primary Health Center
state: Dolakha
Study officials:
affiliation: Possible
name: David Citrin, PhD, MPH
role: STUDY_DIRECTOR
References: