基层医疗中阈下抑郁症患者的护理：真的那么糟糕吗？一项关于全科医生和患者观点的定性研究。
The care of patients with subthreshold depression in primary care: is it all that bad? A qualitative study on the views of general practitioners and patients.
作者信息
Backenstrass Matthias, Joest Katharina, Rosemann Thomas, Szecsenyi Joachim
机构信息
Centre for Psychosocial Medicine, Clinic of General Adult Psychiatry, University of Heidelberg, Vossstr, 4, D-69115 Heidelberg, Germany.
出版信息
BMC Health Serv Res. 2007 Nov 21;7:190. doi: 10.1186/1472-6963-7-190.
BACKGROUND
Studies show that subthreshold depression is highly prevalent in primary care, has impact on the quality of life and causes immense health care costs. Although this points to the clinical relevance of subthreshold depression, contradictory results exist regarding the often self-remitting course of this state. However, first steps towards quality improvement in the care of subthreshold depressive patients are being undertaken. This makes it important to gather information from both a GPs' and a patients' point of view concerning the clinical relevance as well as the status quo of diagnosis and treatment in order to appraise the need for quality improvement research.
METHOD
We conducted qualitative, semi-structured interviews for the questioning of 20 GPs and 20 patients with subthreshold depression on aspects of clinical relevance and on the status quo of diagnosis and treatment. Interviews were transcribed and analyzed on a content analytical theoretical background using Atlas.ti software.
RESULTS
Most of the GPs found subthreshold depression to be clinically significant. Although some problems in diagnosis and treatment were mentioned, the GPs had sensible diagnostic and treatment strategies at hand which resulted from the long and trustful relationship with the patients and which corresponded to the patients' expectations. The patients rather expected their GP to listen to them than to take specific actions towards symptom relief and, in the main, were satisfied with the GPs' care.
CONCLUSION
The study shows that subthreshold depression is a clinically relevant issue for GPs but raises the possibility that quality improvement might not be as necessary as past studies showed. Further quantitative research using larger random samples is needed to determine the effectiveness of the strategies used by the GPs, patients' satisfaction with these strategies and the course of these patients' symptoms in primary care.
背景
研究表明，阈下抑郁在初级保健中极为普遍，会影响生活质量并导致巨额医疗费用。尽管这表明了阈下抑郁的临床相关性，但关于这种状态通常会自行缓解的病程，存在相互矛盾的结果。然而，目前正在采取改善阈下抑郁患者护理质量的初步措施。因此，从全科医生和患者的角度收集有关临床相关性以及诊断和治疗现状的信息，对于评估质量改进研究的必要性至关重要。
方法
我们进行了定性的半结构化访谈，询问了20名全科医生和20名阈下抑郁患者有关临床相关性以及诊断和治疗现状的问题。访谈内容被转录，并在内容分析理论背景下使用Atlas.ti软件进行分析。
结果
大多数全科医生认为阈下抑郁具有临床意义。尽管提到了一些诊断和治疗方面的问题，但全科医生拥有合理的诊断和治疗策略，这些策略源于与患者长期且信任的关系，并且符合患者的期望。患者更期望他们的全科医生倾听他们的心声，而不是采取特定行动缓解症状，并且总体上对全科医生的护理感到满意。
结论
该研究表明，阈下抑郁对全科医生来说是一个具有临床相关性的问题，但也提出了质量改进可能不像过去研究显示的那样必要的可能性。需要使用更大的随机样本进行进一步的定量研究，以确定全科医生所采用策略的有效性、患者对这些策略的满意度以及这些患者在初级保健中的症状病程。
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