Katon Wayne J, Simon Gregory, Russo Joan, Von Korff Michael, Lin Elizabeth H B, Ludman Evette, Ciechanowski Paul, Bush Terry
Department of Psychiatry & Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington 98195-6560, USA.
Med Care. 2004 Dec;42(12):1222-9. doi: 10.1097/00005650-200412000-00009.
Major depression occurs in approximately 11% to 15% of patients with diabetes and is associated with poor glycemic control and adverse medical outcomes. This study examined the rates and predictors of recognition of depression among primary care patients with diabetes and comorbid major depression and the quality of depression care provided during a 12-month period.
This study used automated utilization, pharmacy, and laboratory data from a health maintenance organization to describe the rate of recognition of depression and quality of care provided for patients with major depression and diabetes in the 12-month period before diagnosis. Major depression was diagnosed based on the Patient Health Questionnaire (PHQ-9) that was included in a mail survey sent to 9063 patients on the Group Health diabetes registry from 9 primary care clinics.
Approximately 51% of patients with major depression and diabetes were recognized as depressed by the health care system. Women were more likely to be recognized (odds ratio [OR] 1.58, 95% confidence interval [CI 1.26-1.97]), as were those with dysthymia (OR 3.44, 95% CI 2.08-5.72), panic attacks (OR 1.55, 95% CI 1.19-2.19), patients with more than 7 primary care visits (OR 1.42, 95% CI 1.06-1.91) and patients reporting poor health (OR 1.62, 95% CI 1.04-2.53). Of the 51% of patients with major depression who were recognized, 43% received 1 or more antidepressant prescriptions but only 6.7% received 4 or more psychotherapy sessions during a 12-month period.
There were large gaps in both recognition and quality of depression care provided to patients with major depression and diabetes within a health maintenance organization system.
约11%至15%的糖尿病患者会发生重度抑郁症，且这与血糖控制不佳及不良医疗结局相关。本研究调查了合并重度抑郁症的糖尿病初级保健患者中抑郁症的识别率及预测因素，以及在12个月期间所提供的抑郁症护理质量。
本研究使用了来自一家健康维护组织的自动化利用、药房和实验室数据，以描述在诊断前12个月期间重度抑郁症和糖尿病患者的抑郁症识别率及护理质量。重度抑郁症是根据患者健康问卷（PHQ-9）诊断的，该问卷包含在一份邮寄给来自9家初级保健诊所的9063名团体健康糖尿病登记患者的调查中。
在医疗保健系统中，约51%的重度抑郁症和糖尿病患者被识别为患有抑郁症。女性更有可能被识别（优势比[OR]为1.58，95%置信区间[CI]为1.26 - 1.97），心境恶劣患者也是如此（OR为3.44，95% CI为2.08 - 5.72），惊恐发作患者（OR为1.55，95% CI为1.19 - 2.19），初级保健就诊次数超过7次的患者（OR为1.42，95% CI为1.06 - 1.91）以及报告健康状况不佳的患者（OR为1.62，95% CI为1.04 - 2.53）。在被识别的51%的重度抑郁症患者中，43%在12个月期间接受了1种或更多抗抑郁药物处方，但只有6.7%接受了4次或更多心理治疗疗程。
在健康维护组织系统内，为重度抑郁症和糖尿病患者提供的抑郁症护理在识别和质量方面均存在巨大差距。
