ABSTRACT
BACKGROUND: Substantial data from high-income countries support early interventions in the form of evidence-based Coordinated Specialty Care (CSC) for people experiencing First Episode Psychosis (FEP) to ameliorate symptoms and minimize disability. Chile is unique among Latin American countries in providing universal access to FEP services through a national FEP policy that mandates the identification of FEP individuals in primary care and guarantees delivery of community-based FEP treatments within a public health care system. Nonetheless, previous research has documented that FEP services currently provided at mental health clinics do not provide evidence-based approaches. This proposal aims to address this shortfall by first adapting OnTrackNY (OTNY), a CSC program currently being implemented across the USA, into OnTrackChile (OTCH), and then examine its effectiveness and implementation in Chile. METHODS: The Dynamic Adaptation Process will be used first to inform the adaptation and implementation of OTCH to the Chilean context. Then, a Hybrid Type 1 trial design will test its effectiveness and cost and evaluate its implementation using a cluster-randomized controlled trial (RCT) (N = 300 from 21 outpatient clinics). The OTCH program will be offered in half of these outpatient clinics to individuals ages 15-35. Usual care services will continue to be offered at the other clinics. Given the current COVID-19 pandemic, most research and intervention procedures will be conducted remotely. The study will engage participants over the course of 2 years, with assessments administered at enrollment, 12 months, and 24 months. Primary outcomes include implementation (fidelity, acceptability, and uptake) and service outcomes (person-centeredness, adherence, and retention). Secondary outcomes comprise participant-level outcomes such as symptoms, functioning, and recovery orientation. Over the course of the study, interviews and focus groups with stakeholders will be conducted to better understand the implementation of OTCH. DISCUSSION: Findings from this study will help determine the feasibility, effectiveness, and cost for delivering CSC services in Chile. Lessons learned about facilitators and barriers related to the implementation of the model could help inform the approach needed for these services to be further expanded throughout Latin America. TRIAL REGISTRATION: www. CLINICALTRIALS: gov NCT04247711 . Registered 30 January 2020. TRIAL STATUS: The OTCH trial is currently recruiting participants. Recruitment started on March 1, 2021, and is expected to be completed by December 1, 2022. This is the first version of this protocol (5/12/2021).
Subject(s)
COVID-19 , Psychotic Disorders , Adolescent , Adult , Chile , Humans , Psychotic Disorders/diagnosis , Psychotic Disorders/psychology , Psychotic Disorders/therapy , Randomized Controlled Trials as Topic , Young AdultABSTRACT
The purpose of this article is to analyze the response capacity to SARS-COV-2 of the governments of Chile, Colombia, Ecuador, and Peru, according to the guidelines provided by PAHO. For this, a qualitative methodology was used, with an exploratory, descriptive and analytical approach with the analysis of PAHO variables, among which are surveillance, laboratory, research, and evaluation. From this perspective, it is possible to appreciate the different measures taken by the countries of the Pacific basin with different results. Finally, it can be deduced that social problems prior to the pandemic, whether of an economic nature, supplies, and human resources, affect the health management of the countries analyzed in a pandemic situation.Alternate :El propósito del presente artículo es analizar la capacidad de respuesta frente al SARS- COV-2 de los gobiernos de Chile, Colombia, Ecuador y Perú, de acuerdo con las orientaciones esgrimidas por la OPS. Para lo anterior, se empleó una metodología de carácter cualitativo, con un enfoque exploratorio, descriptivo y analítico con el análisis de las variables de la OPS, entre las que se encuentran Vigilancia, laboratorio, investigación y evaluación. En esta perspectiva se logra apreciar las distintas medidas tomadas por los países de la cuenca del pacifico con diferentes resultados. Finalmente, se deduce que los problemas sociales previos a la pandemia ya sean de índole económico, insumos y recursos humanos, inciden en la gestión sanitaria de los países analizados en situación de pandemia.Alternate :The purpose of this article is to analyze the response capacity to SARS-COV-2 of the governments of Chile, Colombia, Ecuador, and Peru, according to the guidelines provided by PAHO. For this, a qualitative methodology was used, with an exploratory, descriptive and analytical approach with the analysis of PAHO variables, among which are surveillance, laboratory, research, and evaluation. From this perspective, it is possible to appreciate the different measures taken by the countries of the Pacific basin with different results. Finally, it can be deduced that social problems prior to the pandemic, whether of an economic nature, supplies, and human resources, affect the health management of the countries analyzed in a pandemic situation.