Am J Manag Care. 1999 Sep;5(13 Suppl):S783-8; discussion S788-93.
The diagnosis and treatment of depressive disorders are challenges to the primary care physician because of the condition's high prevalence and chronicity, the frequent occurrence of medical and mental health comorbidities, patients' unwillingness to disclose a mental health history, and cost. Primary care physicians also cite lack of time and managed care policies as major barriers to improving outcomes in patients with depression. A potentially more effective approach to treating depression is health management, rather than traditional disease management. In this approach, the focus of care is patients' functional status and quality of life rather than the treatment of a specific health condition in isolation; patients are actively involved with care, and care choices are driven by competing demands. Another approach that may help improve outcomes in depression is the Recognize, Assess, Categorize, and Treat (ReACT) strategy, which is an efficient way to detect and triage patients with depressive disorders according to the severity of illness. Adjunctive aids, such as the use of support staff, monitoring systems, and collaborative care with mental health specialists, also have great potential for improving primary care physicians' effectiveness in treating depression.
由于抑郁症的高患病率和慢性病程、医疗与心理健康共病的频繁发生、患者不愿透露心理健康史以及成本问题，抑郁症的诊断和治疗对初级保健医生来说是一项挑战。初级保健医生还指出，时间不足和管理式医疗政策是改善抑郁症患者治疗效果的主要障碍。一种可能更有效的治疗抑郁症的方法是健康管理，而不是传统的疾病管理。在这种方法中，护理的重点是患者的功能状态和生活质量，而不是孤立地治疗特定的健康状况；患者积极参与护理，护理选择由相互竞争的需求驱动。另一种可能有助于改善抑郁症治疗效果的方法是识别、评估、分类和治疗（ReACT）策略，这是一种根据疾病严重程度检测和分流抑郁症患者的有效方法。辅助手段，如使用支持人员、监测系统以及与心理健康专家的协作护理，在提高初级保健医生治疗抑郁症的有效性方面也具有巨大潜力。
