Jarjoura David, Polen Ann, Baum Elizabeth, Kropp Denize, Hetrick Suzanne, Rutecki Gregory
Community Health Sciences, Northeastern Ohio Universities College of Medicine, Rootstown, Ohio 44272-0095, USA.
J Gen Intern Med. 2004 Jan;19(1):78-84. doi: 10.1111/j.1525-1497.2004.21249.x.
To determine the effectiveness of screening and treatment for depression among ambulatory indigent patients visiting resident physicians.
Two-group randomized trial (N = 33 intervention, N = 28 usual care) with baseline, 6-month, and 12-month outcome measurements.
Internal Medicine Residency Clinic.
Clinic patients over 18 years of age who screened positive for depression on the PRIME-MD during a visit to their resident physician. Patients were not receiving treatment nor seeking care for any emotional problems. All patients were either enrolled in Medicaid or had income below the poverty line.
Resident physicians were educated to follow AHCPR (AHRQ; Agency for Healthcare Research and Quality) guidelines for diagnosis and treatment of depression in a primary care setting. For the intervention group patients, a screening nurse advised residents regarding the positive screen, handed them a standardized protocol outline, and attempted to arrange behavioral care. The patients in the usual care group were provided the results of the screen by the screening nurse before their visit with the resident, and advised to seek care for their symptoms.
Results for the primary outcome of depression symptoms measured with the Beck Depression Inventory (BDI) demonstrated that intervention was successful in reducing symptoms relative to usual care (difference = -4.9 BDI points, P =.05, 95% confidence interval [CI], -9.8 to -0.005 effect size = -0.41). During the 12-month follow-up, 70% of intervention patients were treated for depression (of these, 91% with antidepressants), while 15% of usual care patients were treated with antidepressants for depression. Another 18% of the usual care group had depression noted, but no treatment was identified. BDI differences between intervention and control groups were similar at the 6- and 12-month measures. Quality of life and costs were also measured, but differences between the groups were not significant in this regard.
Screening and treatment for depression by resident physicians was successful in reducing symptoms relative to usual care in an indigent population. Almost twice as many intervention patients as usual care controls demonstrated a substantial reduction (10 BDI points) in symptoms related to depression.
确定在门诊就诊的贫困患者中，由住院医师进行抑郁症筛查和治疗的有效性。
两组随机试验（干预组N = 33，常规治疗组N = 28），进行基线、6个月和12个月的结果测量。
内科住院医师诊所。
在就诊时经PRIME - MD筛查抑郁症呈阳性的18岁以上诊所患者。患者未接受过任何情绪问题的治疗，也未因情绪问题寻求过护理。所有患者均参加了医疗补助计划或收入低于贫困线。
对住院医师进行培训，使其遵循美国医疗保健政策与研究机构（AHRQ）关于初级保健环境中抑郁症诊断和治疗的指南。对于干预组患者，一名筛查护士就筛查阳性结果向住院医师提供建议，递给他们一份标准化方案大纲，并尝试安排行为护理。常规治疗组患者在与住院医师就诊前由筛查护士告知筛查结果，并建议他们针对症状寻求护理。
用贝克抑郁量表（BDI）测量的抑郁症症状这一主要结局的结果表明，相对于常规治疗，干预措施成功减轻了症状（差异=-4.9 BDI分，P = 0.05，95%置信区间[CI]，-9.8至-0.005，效应量=-0.41）。在12个月的随访期间，70%的干预组患者接受了抑郁症治疗（其中91%使用抗抑郁药），而常规治疗组患者中有15%因抑郁症接受了抗抑郁药治疗。常规治疗组另外18%的患者被诊断为患有抑郁症，但未接受治疗。在6个月和12个月的测量中，干预组和对照组之间的BDI差异相似。还对生活质量和成本进行了测量，但在这方面两组之间的差异不显著。
相对于对贫困人群的常规治疗，住院医师对抑郁症进行筛查和治疗成功减轻了症状。干预组患者中表现出与抑郁症相关症状大幅减轻（10 BDI分）的人数几乎是常规治疗对照组的两倍。
