Cole Steven A, Farber Nancy C, Weiner Joseph S, Sulfaro Michelle, Katzelnick David J, Blader Joseph C
Department of Psychiatry, S.U.N.Y. Stony Brook Health Sciences Center, New York 11794, USA.
Dis Manag. 2006 Oct;9(5):266-76. doi: 10.1089/dis.2006.9.266.
This study assessed the feasibility of a telephonic nurse double-disease management program (DDMP) for patients with depression and congestive heart failure. Thirty-five patients with depression and congestive heart failure were entered into a novel DDMP modeled after Wagner's chronic illness care model and implemented as part of a 13-month Breakthrough Series Collaborative administered by the Institute of Healthcare Improvement. Twenty-four patients remained in the program long enough to complete at least one follow-up assessment (ie, 6 weeks or longer). Patients were entered into the program based on depression severity scores from either the interactive voice response (IVR) version of the Hospital Anxiety and Depression Scale (HADS) or the self-administered (or telephonic) Patient Health Questionnaire (PHQ). Because use of the IVR version of the HADS was eliminated after several weeks into the program (because of poor patient acceptance), 19 patients had both entry and follow-up scores on the same instrument (PHQ). Depression "response" was defined as a 50% improvement in PHQ score. Mixed models regression was used to test the statistical significance of change in PHQ scores over time. Patient and clinician reports were obtained to evaluate program acceptability and satisfaction. Eighty-two percent of patients (n = 11) with Major Depressive Disorder (MDD) responded, and 75% of patients (n = 8) with "other depression" (PHQ score < 10) responded. Mean change in PHQ scores for the sample as a whole improved significantly over the 24 weeks of the program (p < 0.0003), as well as for those with major depression and other depression considered separately (p < 0.01 for both). In some patients who refused medication, depression seemed to respond to self-management support interventions of the care manager. Based on patient acceptance and clinicians' reports, the program appeared feasible and possibly effective. DDMP appears feasible and possibly effective. Future clinical trials are warranted.
本研究评估了一项针对抑郁症和充血性心力衰竭患者的电话护士双疾病管理项目（DDMP）的可行性。35名患有抑郁症和充血性心力衰竭的患者参与了一项新颖的DDMP，该项目以瓦格纳慢性病护理模式为蓝本，并作为由医疗改进研究所管理的为期13个月的突破系列协作项目的一部分实施。24名患者在该项目中停留的时间足够长，足以完成至少一次随访评估（即6周或更长时间）。患者根据医院焦虑抑郁量表（HADS）交互式语音应答（IVR）版本或自我管理（或电话）患者健康问卷（PHQ）的抑郁严重程度评分进入该项目。由于该项目开展几周后IVR版本的HADS使用情况不佳（患者接受度低）而被停用，19名患者在同一工具（PHQ）上有入组和随访评分。抑郁“反应”定义为PHQ评分改善50%。采用混合模型回归来检验PHQ评分随时间变化的统计学显著性。获取患者和临床医生报告以评估项目的可接受性和满意度。重度抑郁症（MDD）患者中有82%（n = 11）有反应，“其他抑郁症”（PHQ评分<10）患者中有75%（n = 8）有反应。在该项目的24周内，整个样本的PHQ评分平均变化显著改善（p < 0.0003），重度抑郁症患者和其他抑郁症患者分别来看也是如此（两者p均< 0.01）。在一些拒绝用药的患者中，抑郁症似乎对护理经理的自我管理支持干预有反应。基于患者接受度和临床医生报告，该项目似乎可行且可能有效。DDMP似乎可行且可能有效。有必要开展未来的临床试验。
