Gum Amber M, Areán Patricia A, Hunkeler Enid, Tang Lingqi, Katon Wayne, Hitchcock Polly, Steffens David C, Dickens Jeanne, Unützer Jürgen
Department of Aging and Mental Health, University of South Florida, 13301 Bruce B. Downs Blvd., MHC 1400, Tampa, FL 33612, USA.
Gerontologist. 2006 Feb;46(1):14-22. doi: 10.1093/geront/46.1.14.
For depressed older primary care patients, this study aimed to examine (a) characteristics associated with depression treatment preferences; (b) predictors of receiving preferred treatment; and (c) whether receiving preferred treatment predicted satisfaction and depression outcomes.
Data are from 1,602 depressed older primary care patients who participated in a multisite, randomized clinical trial comparing usual care to collaborative care, which offered medication and counseling for up to 12 months. Baseline assessment included demographics, depression, health information, prior depression treatment, potential barriers, and treatment preferences (medication, counseling). At 12 months, services received, satisfaction, and depression outcomes were assessed.
More patients preferred counseling (57%) than medication (43%). Previous experience with a treatment type was the strongest predictor of preference. In addition, medication preference was predicted by male gender and diagnosis of major depression (vs dysthymia). The collaborative care model greatly improved access to preferred treatment, especially for counseling (74% vs 33% in usual care). Receipt of preferred treatment did not predict satisfaction or depression outcomes; these outcomes were most strongly impacted by treatment condition.
Many depressed older primary care patients desire counseling, which is infrequently available in usual primary care. Discussion of treatment preferences should include an assessment of prior treatment experiences. A collaborative care model that increases collaboration between primary care and mental health professionals can increase access to preferred treatment. If preferred treatment is not available, collaborative care still results in good satisfaction and depression outcomes.
针对患有抑郁症的老年初级保健患者，本研究旨在探讨：（a）与抑郁症治疗偏好相关的特征；（b）接受首选治疗的预测因素；（c）接受首选治疗是否能预测满意度和抑郁症治疗效果。
数据来自1602名患有抑郁症的老年初级保健患者，他们参与了一项多中心随机临床试验，该试验将常规护理与协作护理进行比较，协作护理提供长达12个月的药物治疗和咨询服务。基线评估包括人口统计学、抑郁症、健康信息、既往抑郁症治疗情况、潜在障碍和治疗偏好（药物治疗、咨询）。在12个月时，评估所接受的服务、满意度和抑郁症治疗效果。
比起药物治疗（43%），更多患者倾向于咨询（57%）。既往某种治疗类型的经历是偏好的最强预测因素。此外，男性性别和重度抑郁症（与心境恶劣障碍相比）可预测对药物治疗的偏好。协作护理模式极大地改善了获得首选治疗的机会，尤其是咨询服务（协作护理组为74%，常规护理组为33%）。接受首选治疗并不能预测满意度或抑郁症治疗效果；这些结果受治疗条件的影响最大。
许多患有抑郁症的老年初级保健患者希望接受咨询，但在常规初级保健中这种服务并不常见。讨论治疗偏好时应包括对既往治疗经历的评估。增加初级保健与心理健康专业人员之间协作的协作护理模式可以增加获得首选治疗的机会。如果无法获得首选治疗，协作护理仍能带来良好的满意度和抑郁症治疗效果。
