基于应用的分层护理(妈妈的好心情)在中国初级卫生保健系统中治疗围产期焦虑的混合效果-实施试验

A hybrid effectiveness-implementation trial of application-based tiered care (Mom's Good Mood) in treating perinatal anxiety within a primary health care system in China

基于应用的分层护理(妈妈的好心情)在中国初级卫生保健系统中治疗围产期焦虑的混合效果-实施试验

Authors：Zhu B, Hou Y, Yu X, Jiang M, Lu M, Shang M, Zhen H, Gu Y, Li H, Tao F.

Source：BMJ Glob Health

Abstract

INTRODUCTION: Perinatal anxiety (PNA) is a major public health concern.

METHODS: A hybrid effectiveness-implementation trial was conducted in two antenatal clinics in Hefei, China, to assess the effectiveness and cost-effectiveness of application-based tiered care (Mom's Good Mood, MGM) in treating PNA and to understand how well it fits into routine practices. Pregnant women who scored at least 5 points on the 7-Item Generalised Anxiety Disorder Scale (GAD-7) scale were successively assigned to the control group or the intervention group, which were given the usual care and MGM on usual care, respectively. At 6 months post partum, anxiety, depression and life satisfaction were assessed. Intention-to-treat analysis and the Reach, Effectiveness, Adoption, Implementation and Maintenance framework were adopted.

RESULTS: A total of 214women were assigned to the control group and 341 to the intervention group. The mean changes in GAD-7 scores (Least-squares means, LSM, -1.42, 95%CI -2.18 to -0.66) and the risk of anxiety (adjusted odds ratio, aOR 0.30, 95%CI 0.18 to 0.51) were decreased, and the anxiety remission rate (aOR 2.72, 95%CI 1.69 to 4.40) were improved in the intervention group. Similar findings were observed regarding the change in Edinburgh Postnatal Depression Scale scores (LS -1.92, 95%CI -2.85 to -0.99), depression remission rate (aOR 2.24, 95%CI 1.39 to 3.63) and the risk of depression (aOR 0.57, 95%CI 0.33 to 0.98). MGM only costs 1.88 (US$0.27) per pregnant woman to boost the postpartum anxiety remission rate by 1% and was revealed to have a high reach rate of 78.3%, an adoption rate of 51.3%-80.8%.

CONCLUSION: MGM is a cost-effective and accessible tool in coping with PNA.

摘要

前言：围产期焦虑(PNA)是一个主要的公共卫生问题。

方法: 在中国合肥的两家产前诊所进行了一项混合有效性-实施试验，以评估基于应用的分层护理(妈妈的好心情，MGM)治疗PNA的有效性和成本效益，并了解其与常规实践的契合程度。在7项广泛性焦虑障碍量表(GAD-7)中得分不低于5分的孕妇依次分为对照组或干预组，分别给予常规护理和MGM常规护理。产后6个月进行焦虑、抑郁和生活满意度评估。采用意向治疗分析和可及性、有效性、采用、实施和维持框架。

结果: 共有214名妇女被分配到对照组，341名妇女被分配到干预组。干预组的GAD-7评分(最小二乘平均值，LSM， -1.42, 95%CI -2.18 ~ -0.66)和焦虑风险(校正优势比，aOR 0.30, 95%CI 0.18 ~ 0.51)的平均变化降低，焦虑缓解率(aOR 2.72, 95%CI 1.69 ~ 4.40)改善。在爱丁堡产后抑郁量表评分(LS -1.92, 95%CI -2.85至-0.99)、抑郁缓解率(aOR 2.24, 95%CI 1.39至3.63)和抑郁风险(aOR 0.57, 95%CI 0.33至0.98)的变化方面也观察到类似的结果。每名孕妇只需花费1.88美元(0.27美元)，就能使产后焦虑缓解率提高1%，达到率高达78.3%，采用率为51.3%-80.8%。

结论: MGM是治疗PNA的一种经济可行的工具。