Unützer J, Katon W, Williams J W, Callahan C M, Harpole L, Hunkeler E M, Hoffing M, Arean P, Hegel M T, Schoenbaum M, Oishi S M, Langston C A
Center for Health Services Research, UCLA Neuropsychiatric Institute, Los Angeles, CA, USA.
Med Care. 2001 Aug;39(8):785-99. doi: 10.1097/00005650-200108000-00005.
Late life depression can be successfully treated with antidepressant medications or psychotherapy, but few depressed older adults receive effective treatment.
A randomized controlled trial of a disease management program for late life depression.
Approximately 1,750 older adults with major depression or dysthymia are recruited from seven national study sites.
Half of the subjects are randomly assigned to a collaborative care program where a depression clinical specialist supervised by a psychiatrist and a primary care expert supports the patient's regular primary care provider to treat depression. Intervention services are provided for 12 months using antidepressant medications and Problem Solving Treatment in Primary Care according to a stepped care protocol that varies intervention intensity according to clinical needs. The other half of the subjects are assigned to care as usual.
Subjects are independently assessed at baseline, 3 months, 6 months, 12 months, 18 months, and 24 months. The evaluation assesses the incremental cost-effectiveness of the intervention compared with care as usual. Specific outcomes examined include care for depression, depressive symptoms, health-related quality of life, satisfaction with depression care, health care costs, patient time costs, market and nonmarket productivity, and household income.
The study blends methods from health services and clinical research in an effort to protect internal validity while maximizing the generalizability of results to diverse health care systems. We hope that this study will show the cost-effectiveness of a new model of care for late life depression that can be applied in a range of primary care settings.
老年期抑郁症可通过抗抑郁药物或心理治疗成功治愈，但很少有老年抑郁症患者接受有效治疗。
一项针对老年期抑郁症的疾病管理项目的随机对照试验。
从七个全国性研究地点招募了约1750名患有重度抑郁症或心境恶劣障碍的老年人。
一半的研究对象被随机分配到一个协作护理项目中，在该项目中，由一名精神科医生和一名初级保健专家监督的抑郁症临床专家会支持患者的常规初级保健提供者治疗抑郁症。根据逐步护理方案，使用抗抑郁药物和初级保健中的问题解决疗法提供12个月的干预服务，该方案会根据临床需求改变干预强度。另一半研究对象被分配到常规护理组。
在基线、3个月、6个月、12个月、18个月和24个月时对研究对象进行独立评估。该评估会比较干预措施与常规护理的增量成本效益。所检查的具体结果包括抑郁症护理、抑郁症状、健康相关生活质量、对抑郁症护理的满意度、医疗保健成本、患者时间成本、市场和非市场生产力以及家庭收入。
该研究融合了卫生服务和临床研究的方法，旨在保护内部效度，同时最大限度地提高结果在不同卫生保健系统中的可推广性。我们希望这项研究能够证明一种新型老年期抑郁症护理模式的成本效益，这种模式可应用于一系列初级保健环境中。
