Richardson Laura P, Lewis Charlotte W, Casey-Goldstein Mary, McCauley Elizabeth, Katon Wayne
Department of Pediatrics, Child Health Institute, University of Washington School of Medicine, Seattle, Washington 98115, USA.
J Adolesc Health. 2007 May;40(5):433-9. doi: 10.1016/j.jadohealth.2006.12.006. Epub 2007 Feb 15.
The recent black box warning on antidepressants has drawn attention to controversies regarding the treatment of adolescent depression in primary care settings, but little is known about how providers decide to treat depressed youth and what resources are employed.
We conducted focus groups with 35 providers and staff in nine community-based pediatric practices in rural and urban settings of western Washington State. Discussion topics included perceived barriers to the treatment of depression in youth, how providers addressed these barriers, and the impact of the recent Federal Drug Administration (FDA) black-box warning. Focus groups were audiotaped and professionally transcribed. Qualitative content analysis was conducted using Atlas ti software and differences in coding were resolved via discussion by three independent reviewers.
Based on analysis of interviews, a conceptual model was developed detailing factors influencing primary care providers' (PCP) decisions about depression treatment. The three key themes that influenced doctors' decisions about treating depression were lack of availability of mental health resources in the community, feeling responsible for helping based on long-standing relationships with patients and families, and patient and family beliefs and preferences regarding treatment. Most of the approaches to address barriers were not systemized and were physician dependent. Most providers expressed concern about recent antidepressant warnings, but many continued to treat and none had developed new strategies for closer monitoring of youth initiating treatment with antidepressants.
The decision of when and how PCPs decide to treat adolescent depression is strongly influenced by PCP perceptions of their role in treatment, availability of other treatment resources, and family and patient preferences and resources. Few practices have developed changes in the approach to practice needed to meet FDA black-box recommendations regarding close monitoring of response to medications.
近期抗抑郁药物的黑框警告引发了人们对基层医疗环境中青少年抑郁症治疗争议的关注，但对于医疗服务提供者如何决定治疗抑郁青少年以及使用了哪些资源，人们知之甚少。
我们在华盛顿州西部农村和城市地区的9家社区儿科诊所，与35名医疗服务提供者及工作人员进行了焦点小组讨论。讨论主题包括青少年抑郁症治疗中感知到的障碍、医疗服务提供者如何应对这些障碍以及近期美国食品药品监督管理局（FDA）黑框警告的影响。焦点小组讨论进行了录音并由专业人员转录。使用Atlas ti软件进行定性内容分析，编码差异由三位独立评审员通过讨论解决。
基于访谈分析，构建了一个概念模型，详细阐述了影响基层医疗服务提供者（PCP）抑郁症治疗决策的因素。影响医生治疗抑郁症决策的三个关键主题是社区心理健康资源不足、基于与患者及其家庭的长期关系而产生的帮助责任感，以及患者和家庭对治疗的信念和偏好。大多数应对障碍的方法没有系统化，且依赖于医生。大多数医疗服务提供者对近期的抗抑郁药物警告表示担忧，但许多人仍继续治疗，且没有人制定新策略来更密切地监测开始使用抗抑郁药物治疗的青少年。
基层医疗服务提供者决定何时以及如何治疗青少年抑郁症的决策，在很大程度上受到他们对自身治疗角色的认知、其他治疗资源的可用性以及家庭和患者偏好与资源的影响。很少有诊所在实践方法上做出改变，以满足FDA关于密切监测药物反应的黑框建议。
