Dobscha S K, Gerrity M S, Ward M F
Division of Hospital and Specialty Medicine, Portland Veterans Affairs Medical Center, Portland, Ore., USA.
Eff Clin Pract. 2001 Jul-Aug;4(4):163-71.
Depression remains under-recognized and undertreated by primary care providers. While systematic screening has the potential to improve recognition, providers may overlook screening results because of barriers to accessing the information and the need to address multiple health care issues.
To determine whether limited follow-up of positive findings on depression screening improves provider recognition and initial management of depression.
Before-after study.
Consecutive patients with positive findings on depression screening in a Veterans Affairs primary care clinic in Oregon during the 3 months before (n = 160) and the 3 months after (n = 97) the intervention began.
Patients with positive findings on depression screening completed a self-administered questionnaire (Patient Health Questionnaire), which they turned in to their provider. A mental health nurse subsequently reviewed the records of patients who completed questionnaires and contacted providers when depression was not mentioned in the visit note.
Documentation of depression or suicidal ideation and actions taken for depression (prescription of antidepressant medication, mental health referral, watchful waiting) at the clinic visit.
The mental health nurse received questionnaires for only 39 (40%) postintervention patients. Documentation of depression symptoms (72% vs. 48%; P < 0.001) and suicidal ideation (36% vs. 14%; P < 0.001) significantly improved in the postintervention group compared with the preintervention group. Postintervention patients were also more likely to begin receiving antidepressants (23% vs. 12%; P < 0.05) and to be referred for mental health services (28% vs. 9%; P < 0.001).
A limited intervention can improve provider recognition and initial management of depression in a Veterans Affairs primary care setting.
抑郁症在初级保健提供者中仍未得到充分认识和治疗。虽然系统筛查有可能提高识别率，但由于获取信息存在障碍以及需要处理多个医疗保健问题，提供者可能会忽略筛查结果。
确定抑郁症筛查阳性结果的有限随访是否能提高提供者对抑郁症的识别和初始管理。
前后对照研究。
俄勒冈州一家退伍军人事务初级保健诊所中，干预开始前3个月（n = 160）和干预开始后3个月（n = 97）内抑郁症筛查结果为阳性的连续患者。
抑郁症筛查结果为阳性的患者完成一份自我管理问卷（患者健康问卷），并将其交给提供者。随后，一名心理健康护士查阅完成问卷的患者记录，当就诊记录中未提及抑郁症时与提供者联系。
就诊时抑郁症或自杀意念的记录以及针对抑郁症采取的行动（抗抑郁药物处方、心理健康转诊、观察等待）。
心理健康护士仅收到39名（40%）干预后患者的问卷。与干预前组相比，干预后组抑郁症症状的记录（72%对4８%；P < 0.001）和自杀意念的记录（36%对14%；P < 0.001）有显著改善。干预后患者也更有可能开始接受抗抑郁药物治疗（23%对12%；P < 0.05）并被转诊接受心理健康服务（28%对9%；P < 0.001）。
在退伍军人事务初级保健环境中，有限的干预可以提高提供者对抑郁症的识别和初始管理。
