The 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. This 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. Of 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. There 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.

中文翻译：

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在乌干达西南部姆巴拉拉遵守将精神卫生服务纳入初级卫生保健的临床指南：医疗记录审查

乌干达卫生部将精神保健下放到区一级；制定了乌干达临床指南 (UCG)；以及在识别、管理和转诊常见精神障碍患者方面经过培训的初级卫生保健 (PHC) 提供者。这旨在促进将精神卫生服务纳入该国的初级保健。这里的“常见精神障碍”是指 UCG 中指出的精神、神经和物质使用状况。然而，心理健康融入一般医疗保健的程度仍然未知。本研究旨在确定 PHC 提供者在识别和管理精神障碍方面对 UCG 的依从性水平。这是对 2018 年 11 月和 12 月收集的患者信息的前瞻性医疗记录审查，2019 年 3 月和 4 月在乌干达西南部的两个卫生中心（III 和 IV）。使用清单收集数据（医疗机构级别；患者的性别和年龄；以及精神障碍诊断、管理）。使用平均值和标准偏差分析连续数据，而使用卡方分析分类数据。进行多变量逻辑回归分析以确定 PHC 提供者遵守将精神卫生服务整合到 PHC 的临床指南的预测因素。分析在 95% 的显着性水平下进行。在研究期间，在研究医疗机构的 6093 名患者记录中，146 名 (2.4%) 被诊断为精神或神经障碍。常见的诊断为癫痫 91 (1.5%) 和双相 25 (0.4%)。处方最多的药物是卡马西平 65 (44.5%) 和苯巴比妥 26 (17.8%)。在三级保健中心不当开出的用于精神诊断的药物包括用于癫痫 3 的氯丙嗪 (2.1%) 和用于癫痫 1 的氟哌啶醇 (0.7%)。女性（aOR：0.52，95% CI 0.39-0.69）和 61 岁以上（aOR：3.02，95% CI 1.40-6.49）是精神障碍进入 HMIS 登记册的预测因素。初级保健提供者在将精神卫生服务纳入常规护理方面的做法发生了显着变化，这反映在诊断和治疗并进入基于修改后的纸质 HMIS 登记册的精神障碍数量的增加。1%) 和氟哌啶醇治疗癫痫 1 (0.7%)。女性（aOR：0.52，95% CI 0.39-0.69）和 61 岁以上（aOR：3.02，95% CI 1.40-6.49）是精神障碍进入 HMIS 登记册的预测因素。初级保健提供者在将精神卫生服务纳入常规护理方面的做法发生了显着变化，这反映在诊断和治疗并进入基于修改后的纸质 HMIS 登记册的精神障碍数量的增加。1%) 和氟哌啶醇治疗癫痫 1 (0.7%)。女性（aOR：0.52，95% CI 0.39-0.69）和 61 岁以上（aOR：3.02，95% CI 1.40-6.49）是精神障碍进入 HMIS 登记册的预测因素。初级保健提供者在将精神卫生服务纳入常规护理方面的做法发生了显着变化，这反映在诊断和治疗并进入基于修改后的纸质 HMIS 登记册的精神障碍数量的增加。