Robinson W David, Geske Jenenne A, Prest Layne A, Barnacle Rachel
Department of Family Medicine, University of Nebraska Medical Center, Omaha, NE 68198-3075, USA.
J Am Board Fam Pract. 2005 Mar-Apr;18(2):79-86. doi: 10.3122/jabfm.18.2.79.
Depression costs the United States dollars 40 billion annually. Primary care physicians play a key role in the identification and treatment of depression. This study focused on the treatment options recommended by physicians and whether physicians were following the recommended treatment guidelines.
We recorded treatment recommendations by examining charts for all patients with newly detected depression. The patients were from 44 family medicine practitioners and 23 general internal medicine practitioners in a Midwest university medical center setting.
For both medical specialties combined, pharmacotherapy was the most widely used intervention (recommended for 52% of patients), whereas psychotherapy alone was the least frequently used intervention (recommended for 4% of patients). Family medicine practitioners recommended combination treatment (pharmacotherapy and psychotherapy) more frequently than did general internal medicine practitioners (P = .022), and female physicians recommended combination treatment more frequently than did male physicians (P = .010).
Pharmacotherapy was found to be the most widely used treatment despite current evidence-based recommendations. Barriers to effective treatment plan are discussed. The implications for mental health interventions, combination therapy, and cost offset are also discussed. Further research exploring the negotiation process during the patient-provider encounter would shed light on patient and physician factors influencing treatment decisions.
抑郁症每年给美国造成400亿美元的损失。初级保健医生在抑郁症的识别和治疗中起着关键作用。本研究聚焦于医生推荐的治疗方案以及医生是否遵循推荐的治疗指南。
我们通过检查所有新确诊抑郁症患者的病历记录治疗建议。这些患者来自中西部一所大学医学中心的44名家庭医学从业者和23名普通内科从业者。
对于这两个医学专业的患者而言，药物治疗是使用最广泛的干预措施（52%的患者被推荐使用），而单独的心理治疗是使用最少的干预措施（4%的患者被推荐使用）。家庭医学从业者比普通内科从业者更频繁地推荐联合治疗（药物治疗和心理治疗）（P = 0.022），女性医生比男性医生更频繁地推荐联合治疗（P = 0.010）。
尽管有当前基于证据的推荐，但发现药物治疗是使用最广泛的治疗方法。讨论了有效治疗计划的障碍。还讨论了对心理健康干预、联合治疗和成本抵消的影响。进一步探索患者与提供者互动期间协商过程的研究将揭示影响治疗决策的患者和医生因素。
