Dalby Dawn M, Hirdes John P, Hogan David B, Patten Scott B, Beck Cynthia A, Rabinowitz Terry, Maxwell Colleen J
Department of Kinesiology and Physical Education, Wilfrid Laurier University, Waterloo, Ontario, Canada.
Int J Geriatr Psychiatry. 2008 Jun;23(6):650-9. doi: 10.1002/gps.1987.
To examine the prevalence and correlates of potentially inappropriate pharmacotherapy (including potential under-treatment) for depression in adult home care clients.
A cross-sectional study of clients receiving services from Community Care Access Centres in Ontario. Three thousand three hundred and twenty-one clients were assessed with the Resident Assessment Instrument for Home Care (RAI-HC). A score of 3 or greater on the Depression Rating Scale (DRS), a validated scale embedded within the RAI-HC, indicates the presence of symptoms of depression. Medications listed on the RAI-HC were used to categorize treatment into two groups: potentially appropriate and potentially inappropriate antidepressant drug therapy. Adjusted logistic regression models were used to explore relevant predictors of potentially inappropriate pharmacotherapy.
12.5% (n=414) of clients had symptoms of depression and 17% received an appropriate antidepressant. Over half of clients (64.5%) received potentially inappropriate pharmacotherapy (including potential under-treatment). Age 75 years or older, higher levels of caregiver stress and the presence of greater comorbidity were associated with a higher risk of potentially inappropriate pharmacotherapy in multivariate analyses. Documentation of any psychiatric diagnosis on the RAI-HC and receiving more medications were significantly associated with a greater likelihood of appropriate drug treatment.
Most clients with significant depressive symptoms were not receiving appropriate pharmacotherapy. Having a documented diagnosis of a psychiatric condition on the RAI-HC predicted appropriate pharmacotherapy. By increasing recognition of psychiatric conditions, the use of standardized, comprehensive assessment instruments in home care may represent an opportunity to improve mental health care in these settings.
研究成年家庭护理患者中潜在不适当药物治疗（包括潜在治疗不足）在抑郁症方面的患病率及其相关因素。
对安大略省社区护理接入中心提供服务的患者进行横断面研究。使用居家护理居民评估工具（RAI-HC）对3321名患者进行评估。RAI-HC中包含的经过验证的抑郁评定量表（DRS）得分3分或更高表明存在抑郁症状。使用RAI-HC上列出的药物将治疗分为两组：潜在适当和潜在不适当的抗抑郁药物治疗。采用调整后的逻辑回归模型探索潜在不适当药物治疗的相关预测因素。
12.5%（n = 414）的患者有抑郁症状，17%的患者接受了适当的抗抑郁药物治疗。超过一半的患者（64.5%）接受了潜在不适当的药物治疗（包括潜在治疗不足）。在多变量分析中，75岁及以上的年龄、更高水平的照顾者压力以及更多的合并症与潜在不适当药物治疗的较高风险相关。RAI-HC上记录有任何精神科诊断以及服用更多药物与适当药物治疗的可能性显著相关。
大多数有明显抑郁症状的患者未接受适当的药物治疗。在RAI-HC上记录有精神疾病诊断可预测适当的药物治疗。通过提高对精神疾病的认识，在家庭护理中使用标准化、全面的评估工具可能是改善这些环境中精神卫生保健的一个机会。
