Dietrich Allen J, Oxman Thomas E, Williams John W, Schulberg Herbert C, Bruce Martha L, Lee Pamela W, Barry Sheila, Raue Patrick J, Lefever Jean J, Heo Moonseong, Rost Kathryn, Kroenke Kurt, Gerrity Martha, Nutting Paul A
Dartmouth Medical School, HB 7250, Hanover, NH 03755, USA.
BMJ. 2004 Sep 11;329(7466):602. doi: 10.1136/bmj.38219.481250.55. Epub 2004 Sep 2.
To test the effectiveness of an evidence based model for management of depression in primary care with support from quality improvement resources.
Cluster randomised controlled trial.
Five healthcare organisations in the United States and 60 affiliated practices.
405 patients, aged > or = 18 years, starting or changing treatment for depression.
Care provided by clinicians, with staff providing telephone support under supervision from a psychiatrist.
Severity of depression at three and six months (Hopkins symptom checklist-20): response to treatment (> or = 50% decrease in scores) and remission (score of < 0.5).
At six months, 60% (106 of 177) of patients in intervention practices had responded to treatment compared with 47% (68 of 146) of patients in usual care practices (P = 0.02). At six months, 37% of intervention patients showed remission compared with 27% for usual care patients (P = 0.014). 90% of intervention patients rated their depression care as good or excellent at six months compared with 75% of usual care patients (P = 0.0003).
Resources such as quality improvement programmes can be used effectively in primary care to implement evidence based management of depression and improve outcomes for patients with depression.
在质量改进资源的支持下，测试一种基于证据的初级保健中抑郁症管理模式的有效性。
整群随机对照试验。
美国的五个医疗保健机构及60个附属医疗机构。
405名年龄≥18岁、开始或改变抑郁症治疗方案的患者。
由临床医生提供护理，工作人员在精神科医生的监督下提供电话支持。
3个月和6个月时的抑郁严重程度（霍普金斯症状清单-20）：治疗反应（评分降低≥50%）和缓解情况（评分<0.5）。
6个月时，干预组177名患者中有60%（106名）对治疗有反应，而常规护理组146名患者中有47%（68名）有反应（P = 0.02）。6个月时，干预组37%的患者显示缓解，而常规护理组为27%（P = 0.014）。6个月时，90%的干预组患者将其抑郁症护理评为良好或优秀，而常规护理组患者为75%（P = 0.0003）。
质量改进计划等资源可有效地用于初级保健，以实施基于证据的抑郁症管理，并改善抑郁症患者的治疗效果。
