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Immediate versus sustained effects: interrupted time series analysis of a tailored intervention

机译：即时效果与持续效果：中断时间量身定制的干预措施分析

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Background Detailed intervention descriptions and robust evaluations that test intervention impact—and explore reasons for impact—are an essential part of progressing implementation science. Time series designs enable the impact and sustainability of intervention effects to be tested. When combined with time series designs, qualitative methods can provide insight into intervention effectiveness and help identify areas for improvement for future interventions. This paper describes the development, delivery, and evaluation of a tailored intervention designed to increase primary health care professionals’ adoption of a national recommendation that women with mild to moderate postnatal depression (PND) are referred for psychological therapy as a first stage treatment. Methods Three factors influencing referral for psychological treatment were targeted using three related intervention components: a tailored educational meeting, a tailored educational leaflet, and changes to an electronic system data template used by health professionals during consultations for PND. Evaluation comprised time series analysis of monthly audit data on percentage referral rates and monthly first prescription rates for anti-depressants. Interviews were conducted with a sample of health professionals to explore their perceptions of the intervention components and to identify possible factors influencing intervention effectiveness. Results The intervention was associated with a significant, immediate, positive effect upon percentage referral rates for psychological treatments. This effect was not sustained over the ten month follow-on period. Monthly rates of anti-depressant prescriptions remained consistently high after the intervention. Qualitative interview findings suggest key messages received from the intervention concerned what appropriate antidepressant prescribing is, suggesting this to underlie the lack of impact upon prescribing rates. However, an understanding that psychological treatment can have long-term benefits was also cited. Barriers to referral identified before intervention were cited again after the intervention, suggesting the intervention had not successfully tackled the barriers targeted. Conclusion A time series design allowed the initial and sustained impact of our intervention to be tested. Combined with qualitative interviews, this provided insight into intervention effectiveness. Future research should test factors influencing intervention sustainability, and promote adoption of the targeted behavior and dis-adoption of competing behaviors where appropriate.
机译：背景技术详细的干预措施描述和可靠的评估，以测试干预措施的影响，并探讨造成影响的原因，是不断发展的实施科学的重要组成部分。时间序列设计可以测试干预效果的影响和可持续性。当与时间序列设计结合使用时，定性方法可以提供对干预效果的洞察力，并帮助确定需要改进的领域，以便将来进行干预。本文介绍了量身定制的干预措施的开发，实施和评估，旨在增加初级卫生保健专业人员采纳一项全国性建议，即轻度至中度产后抑郁症（PND）的妇女应作为心理治疗的第一阶段治疗。方法使用三个相关的干预措施，针对影响转诊至心理治疗的三个因素进行针对性：量身定制的教育会议，量身定制的教育传单以及对医疗专业人员在PND咨询期间使用的电子系统数据模板的更改。评估包括对抗抑郁药的推荐率和每月首次处方率的每月审核数据进行时间序列分析。采访了卫生专业人员样本，以探讨他们对干预成分的看法，并确定影响干预效果的可能因素。结果干预与心理治疗的转诊百分比显着，直接，积极的影响有关。在随后的10个月中，这种效果并未持续。干预后，抗抑郁药处方的每月使用率一直保持较高水平。定性访谈的结果表明，从干预措施中收到的关键信息涉及适当的抗抑郁药处方是什么，表明这是对处方率缺乏影响的基础。但是，也有人认为心理治疗可以带来长期利益。干预之前再次提及了在干预之前确定的转诊障碍，这表明干预尚未成功解决目标障碍。结论时间序列设计可以测试我们干预措施的初步和持续影响。结合定性访谈，可以深入了解干预效果。未来的研究应测试影响干预措施可持续性的因素，并在适当情况下促进采用目标行为和不采用竞争行为。

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