Katon W, von Korff M, Lin E, Bush T, Ormel J
Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle 98195.
Med Care. 1992 Jan;30(1):67-76. doi: 10.1097/00005650-199201000-00007.
Among a sample of 119 distressed high-utilizers of primary care, 45% of patients evaluated by a psychiatrist as needing antidepressant treatment had been treated in the year before the examination. However, only 11% of the patients needing antidepressants had received adequate dosage and duration of pharmacotherapy. In the year following the intervention, study patients whose physicians were advised regarding treatment during a psychiatric consultation were more likely to receive antidepressant medications (52.7%) relative to a randomized control group (36.1%). However, the intervention did not significantly increase the provision of adequate antidepressant therapy (37.1% vs 27.9%). Among study patients using antidepressants, patient characteristics did not differentiate patients who received adequate dosage and duration of antidepressant medications from those who did not. Analysis of data on the duration of antidepressant therapy for all health maintenance organization enrollees initiating use of antidepressants showed that only 20% of patients who had been given prescriptions for first-generation antidepressants (amitriptyline, imipramine, or doxepin) filled four or more prescriptions in the following six months, compared to 34% of patients who had prescriptions for newer antidepressants (nortriptyline, desipramine, trazodone and fluoxetine). Experimental research evaluating whether these newer medications (with more favorable side effect profiles) improve adherence, and thereby patient outcome, is needed.
在119名初级保健高使用量的困扰患者样本中，经精神科医生评估需要抗抑郁治疗的患者中有45%在检查前一年接受过治疗。然而，需要抗抑郁药物治疗的患者中只有11%接受了足够剂量和疗程的药物治疗。在干预后的一年里，与随机对照组（36.1%）相比，在精神科会诊期间医生得到治疗建议的研究患者更有可能接受抗抑郁药物治疗（52.7%）。然而，干预并没有显著增加足够的抗抑郁治疗的提供（37.1%对27.9%）。在使用抗抑郁药物的研究患者中，患者特征并不能区分接受了足够剂量和疗程抗抑郁药物治疗的患者和未接受治疗的患者。对所有开始使用抗抑郁药物的健康维护组织参保者的抗抑郁治疗持续时间数据的分析表明，在接下来的六个月里，只有20%开具第一代抗抑郁药物（阿米替林、丙咪嗪或多塞平）处方的患者服用了四张或更多处方，相比之下，开具新型抗抑郁药物（去甲替林、地昔帕明、曲唑酮和氟西汀）处方的患者这一比例为34%。需要进行实验研究来评估这些新型药物（副作用较小）是否能提高依从性，从而改善患者的治疗效果。
