Adherence to clinical guidelines in integration of mental health services into primary health care in Mbarara, southwestern Uganda: a medical records review

International Journal of Mental Health Systems

Moses Ocan¹  Celestino Obua²  Samuel Maling³  Edith K. Wakida³  Godfrey Z. Rukundo³  Zohray M. Talib⁴  Peter Ssebutinde⁵  Elialilia S. Okello⁶ 

[1] Department of Pharmacology and Therapeutics, Makerere University College of Health Sciences, Kampala, Uganda;Department of Pharmacology, Mbarara University of Science and Technology, Mbarara, Uganda;Office of the Vice Chancellor, Mbarara University of Science and Technology, Mbarara, Uganda;Department of Psychiatry, Mbarara University of Science and Technology, P. O. Box 1410, Mbarara, Uganda;Department of Psychiatry, Mbarara University of Science and Technology, P. O. Box 1410, Mbarara, Uganda;Department of Medical Education, California University of Science and Medicine, San Bernardino, CA, USA;Mbarara, Uganda;Mwanza Intervention Trials Unit, Mwanza, Tanzania;

关键词: Uganda Clinical Guidelines (UCG);    Adherence;    PHC providers;    Health management information system;   

DOI  :  10.1186/s13033-021-00488-6

来源: Springer

【 摘 要 】

BackgroundThe Ugandan Ministry of Health decentralized mental healthcare to the district level; developed the Uganda Clinical Guidelines (UCG); and trained primary health care (PHC) providers in identification, management, and referral of individuals with common mental disorders. This was intended to promote integration of mental health services into PHC in the country. ‘Common mental disorders’ here refers to mental, neurological and substance use conditions as indicated in the UCG. However, the extent of integration of mental health into general healthcare remains unknown. This study aimed to establish the level of adherence of PHC providers to the UCG in the identification and management of mental disorders.MethodsThis was a prospective medical record review of patient information collected in November and December 2018, and March and April 2019 at two health centers (III and IV) in southwestern Uganda. Data (health facility level; sex and age of the patient; and mental disorder diagnosis, management) was collected using a checklist. Continuous data was analyzed using means and standard deviation while categorical data was analyzed using Chi-square. Multivariable logistic regression analysis was performed to establish predictors of PHC provider adherence to the clinical guidelines on integration of mental health services into PHC. The analysis was conducted at a 95% level of significance.ResultsOf the 6093 records of patients at the study health facilities during the study period, 146 (2.4%) had a mental or neurological disorder diagnosis. The commonly diagnosed disorders were epilepsy 91 (1.5%) and bipolar 25 (0.4%). The most prescribed medications were carbamazepine 65 (44.5%), and phenobarbital 26 (17.8%). The medicines inappropriately prescribed at health center III for a mental diagnosis included chlorpromazine for epilepsy 3 (2.1%) and haloperidol for epilepsy 1 (0.7%). Female gender (aOR: 0.52, 95% CI 0.39–0.69) and age 61+ years (aOR: 3.02, 95% CI 1.40–6.49) were predictors of a mental disorder entry into the HMIS register.ConclusionThere was a noticeable change of practice by PHC providers in integrating mental health services in routine care as reflected by the rise in the number of mental disorders diagnosed and treated and entered into the modified paper based HMIS registers.

【 授权许可】

CC BY