Pincus H A, Pechura C M, Elinson L, Pettit A R
Western Psychiatric Institute and Clinic, Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Gen Hosp Psychiatry. 2001 Nov-Dec;23(6):311-8. doi: 10.1016/s0163-8343(01)00165-7.
Depression is a serious, often chronic disease that can be managed effectively with a chronic care model in primary care settings. Depressed persons are likely to be seen by a primary care physician, but their condition often goes unrecognized and untreated. There are effective treatment models that consist of efficacious psychotherapeutic and pharmacological interventions, use of evidence-based guidelines for primary care treatment of depression, development of explicit plans and protocols, reorganization of practice, longitudinal follow-up, patient self-management, decision-making support, access to community resources and leadership commitment. Moving these models into everyday practice requires overcoming both clinical and system barriers. Barriers consist of issues surrounding patients, providers, practices, plans, and purchasers. An understanding of these barriers at each level helps to provide a framework for the changes required to overcome them. The Robert Wood Johnson Foundation National Program on Depression in Primary Care will seek to apply simultaneously both clinical and system strategies in a new five-year initiative to overcome these barriers.
抑郁症是一种严重的、通常为慢性的疾病，在初级保健环境中可通过慢性病护理模式得到有效管理。抑郁症患者很可能会去看初级保健医生，但他们的病情往往未被识别和治疗。有一些有效的治疗模式，包括有效的心理治疗和药物干预、使用基于证据的初级保健抑郁症治疗指南、制定明确的计划和方案、调整医疗实践、进行长期随访、患者自我管理、决策支持、获取社区资源以及领导层的承诺。将这些模式应用于日常实践需要克服临床和系统障碍。障碍包括围绕患者、医疗服务提供者、医疗实践、计划和购买者的问题。了解每个层面的这些障碍有助于为克服它们所需的变革提供一个框架。罗伯特·伍德·约翰逊基金会初级保健抑郁症国家项目将在一项新的五年倡议中同时寻求应用临床和系统策略来克服这些障碍。
