Rollman Bruce L, Hanusa Barbara H, Belnap Bea Herbeck, Gardner William, Cooper Lisa A, Schulberg Herbert C
Division of General Internal Medicine, Center for Research on Health Care, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.
Gen Hosp Psychiatry. 2002 Nov-Dec;24(6):381-90. doi: 10.1016/s0163-8343(02)00219-0.
Racial variations in the use of effective medical care and subsequent clinical outcomes have been identified for many medical conditions. Still, it is unclear whether racial variations in care and clinical outcomes exist for depressed primary care patients. Primary care patients presenting for routine treatment were screened for major depression as part of a study to disseminate a depression treatment guideline. Primary care physicians (PCPs) were informed of their patients' depression via an electronic medical record system and asked whether they agreed with the diagnosis. Treatment patterns and depressive symptoms over the following six-months were assessed by chart review and the Hamilton Rating Scale for Depression, respectively. Over a 20-month period, 8,944 African-American and Caucasian patients aged 18-64 were approached for screening. African-Americans were less likely to agree to undergo screening than Caucasians (83% vs. 88%; P<.0001), but those doing so were more likely to report mood symptoms (26% vs. 15%; P<.001). 204 patients, including 52 African-Americans (25%), met protocol-eligibility criteria and completed a baseline interview. Baseline sociodemographic and clinical characteristics, and PCPs' agreement rate with the depression diagnosis were similar. Although PCPs were less likely to counsel their African-American than Caucasian patients for depression (P=.03), this difference resolved after adjusting for education level, employment, and insurance status and we found no other variations in the depression care provided or in clinical outcomes by race. We found little racial variation in either process measures or clinical outcomes for depression in our sample of African-American and Caucasian primary care patients.
对于许多医疗状况，已发现有效医疗护理的使用情况及后续临床结果存在种族差异。然而，目前尚不清楚在初级护理的抑郁症患者中，护理和临床结果是否存在种族差异。作为一项传播抑郁症治疗指南研究的一部分，对前来接受常规治疗的初级护理患者进行了重度抑郁症筛查。通过电子病历系统告知初级护理医生（PCP）其患者的抑郁症情况，并询问他们是否同意该诊断。分别通过病历审查和汉密尔顿抑郁量表评估接下来六个月的治疗模式和抑郁症状。在20个月的时间里，共邀请了8944名年龄在18 - 64岁的非裔美国人和白人患者进行筛查。非裔美国人比白人更不愿意接受筛查（83%对88%；P <.0001），但接受筛查的非裔美国人更有可能报告情绪症状（26%对15%；P <.001）。204名患者，包括52名非裔美国人（25%），符合方案入选标准并完成了基线访谈。基线社会人口统计学和临床特征以及PCP对抑郁症诊断的同意率相似。尽管PCP向非裔美国患者提供抑郁症咨询的可能性低于白人患者（P = 0.03），但在调整教育水平、就业和保险状况后，这种差异消失了，并且我们发现按种族划分，在提供的抑郁症护理或临床结果方面没有其他差异。在我们的非裔美国人和白人初级护理患者样本中，我们发现抑郁症的过程指标或临床结果几乎没有种族差异。
