Kates Nick, Mach Michele
Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, Ontario.
Can J Psychiatry. 2007 Feb;52(2):77-85. doi: 10.1177/070674370705200202.
To review randomized controlled trials (RCTs) evaluating chronic disease management models for depression in primary care and to look at the implications for clinical practice in Canada.
We reviewed all RCTs conducted between 1992 and 2006, including other reviews and analyses of pooled data. Using various search terms, we searched PsycINFO, Cinahl (1982 to May 2005), MEDLINE (1995 to 2005), EMBASE, The Cochrane Library, and PubMed.
There is conclusive evidence for the benefits of changing systems of care delivery to support the more effective management of depression in primary care. Most studies have demonstrated improved outcomes in terms of symptom reduction, relapse prevention, functioning in the community, adherence to treatment, community and workplace involvement, and satisfaction with care received.
Primary care practices need to examine how they can incorporate different concepts and models for managing depression. Components to consider include case registries, care managers or coordinators, treatment algorithms, follow-up and monitoring after a treated episode, care and relapse prevention plans, visits by psychiatrists, and training and ongoing education for all providers.
回顾评估初级保健中抑郁症慢性病管理模式的随机对照试验（RCT），并探讨其对加拿大临床实践的影响。
我们回顾了1992年至2006年间开展的所有随机对照试验，包括对汇总数据的其他综述和分析。我们使用各种检索词，在PsycINFO、Cinahl（1982年至2005年5月）、MEDLINE（1995年至2005年）、EMBASE、Cochrane图书馆和PubMed中进行检索。
有确凿证据表明，改变护理提供系统有助于在初级保健中更有效地管理抑郁症。大多数研究表明，在症状减轻、预防复发、社区功能、治疗依从性、社区和工作场所参与度以及对所接受护理的满意度方面，结果有所改善。
初级保健机构需要审视如何将不同理念和模式纳入抑郁症管理中。需要考虑的要素包括病例登记、护理经理或协调员、治疗算法、治疗后随访和监测、护理及预防复发计划、精神科医生出诊，以及为所有医护人员提供培训和持续教育。
