Von Korff M, Katon W, Unützer J, Wells K, Wagner E H
Center for Health Studies, Group Health Cooperative, Seattle, WA 98101, USA.
J Fam Pract. 2001 Jun;50(6):E1.
Potential solutions for barriers to improved organization of care of depressive illness were identified. These included (1) aligning efforts to improve depression care with broader strategies for improving care of other chronic conditions; (2) increasing the availability of depression case management services in primary care; (3) developing registries and reminder systems to ensure active follow-up of depressed patients; (4) achieving agreement on how depression outcomes should be measured to provide outcomes-based performance standards; (5) providing greater support from mental health specialists for management of depressed patients by primary care providers; (6) campaigns to reduce the stigma associated with treatment of depressive illness; (7) increased dissemination of interventions that activate and empower patients managing a depressive illness; (8) redefining the lack of time of primary care providers for high-quality depression care as issues in organization of care and provider training; and (9) development of incentives (organizational or financial) for high-quality depression care. Research needs were identified according to what has been learned to date. Identified research needs included: studies of approaches to organization of case management, research in new populations (e.g., new diagnostic groups, rural populations, the disadvantaged, the elderly, and those with chronic medical illnesses), research on stepped care and relapse prevention strategies, evaluation of the societal benefits of improved depression care, and multisite trials and meta-analytic approaches that can provide adequate statistical power to assess societal benefits of improved care.
确定了改善抑郁症护理组织障碍的潜在解决方案。这些方案包括：(1) 将改善抑郁症护理的努力与改善其他慢性病护理的更广泛战略相结合；(2) 在初级保健中增加抑郁症病例管理服务的可及性；(3) 建立登记册和提醒系统，以确保对抑郁症患者进行积极随访；(4) 就如何衡量抑郁症治疗结果以提供基于结果的绩效标准达成共识；(5) 让精神卫生专家为初级保健提供者管理抑郁症患者提供更多支持；(6) 开展运动以减少与抑郁症治疗相关的污名化；(7) 更多地传播能使管理抑郁症的患者积极参与并获得权力的干预措施；(8) 将初级保健提供者缺乏高质量抑郁症护理时间的问题重新定义为护理组织和提供者培训方面的问题；(9) 制定高质量抑郁症护理的激励措施（组织或财务方面）。根据迄今所学到的知识确定了研究需求。确定的研究需求包括：病例管理组织方法的研究、新人群（如新诊断群体、农村人口、弱势群体、老年人以及患有慢性疾病的人群）的研究、逐步护理和预防复发策略的研究、改善抑郁症护理的社会效益评估，以及能够提供足够统计效力以评估改善护理社会效益的多中心试验和荟萃分析方法。
