Stiefel F, Zdrojewski C, Bel Hadj F, Boffa D, Dorogi Y, So A, Ruiz J, de Jonge P
Service de Psychiatrie de Liaison, University Hospital of Lausanne, Lausanne, Switzerland.
Psychother Psychosom. 2008;77(4):247-56. doi: 10.1159/000129658. Epub 2008 Apr 28.
This study evaluated a multifaceted psychiatric intervention targeted at the complex medically ill identified by means of the INTERMED, an instrument to assess case complexity.
Of 885 rheumatology inpatients and diabetes outpatients who were assessed for eligibility, 247 were identified as complex (INTERMED score >20) and randomized to the intervention (n = 125, 84 rheumatology and 41 diabetes patients) or care as usual (n = 122, 78 rheumatology and 44 diabetes patients). For the majority of the cases the multifaceted intervention consisted of an intervention conducted by a psychiatric liaison nurse and/or of referral to a liaison psychiatrist, followed by advice to the treating physician or organization of a multidisciplinary case conference. Baseline and follow-up at months 3, 6, 9 and 12 measured prevalence of major depression (Mini-International Neuropsychiatric Interview), depressive symptoms (Center for Epidemiological Studies Depression Rating Scale), physical and mental health (SF-36), quality of life (EuroQol), health care utilization and HbA(1c) levels (diabetic patients).
Prevalence of major depression was reduced from 61% (T0) to 28% (T4) in the intervention group and remained stable in care as usual (57% at T0 to 50% at T4). Compared to care as usual, significant improvement over time was observed in the intervention group with regard to depressive symptoms (F = 11.9; p = 0.001), perception of physical (F = 5.7; p = 0.018) and mental health (F = 3.9; p = 0.047) and quality of life (F = 21.8; p < 0.001). Effects tended to be stronger in diabetes patients, in patients with baseline major depression and in patients with moderate INTERMED scores. Finally, hospital admissions occurred less often in the intervention group, reaching statistical significance for the period between 6 and 9 months of follow-up (p = 0.02).
The results suggest that a psychiatric intervention targeted for complex medical patients can improve health outcomes.
本研究评估了一种针对通过INTERMED（一种评估病例复杂性的工具）识别出的复杂内科疾病患者的多方面精神科干预措施。
在885名接受资格评估的风湿病住院患者和糖尿病门诊患者中，247名被确定为复杂病例（INTERMED评分>20），并被随机分为干预组（n = 125，84名风湿病患者和41名糖尿病患者）或常规护理组（n = 122，78名风湿病患者和44名糖尿病患者）。对于大多数病例，多方面干预措施包括由精神科联络护士进行干预和/或转介给联络精神科医生，随后向治疗医生提供建议或组织多学科病例讨论会。在基线以及第3、6、9和12个月进行随访，测量重度抑郁症患病率（迷你国际神经精神访谈）、抑郁症状（流行病学研究中心抑郁量表）、身心健康（SF - 36）、生活质量（欧洲五维度健康量表）、医疗保健利用率以及糖化血红蛋白水平（糖尿病患者）。
干预组中重度抑郁症患病率从61%（T0）降至28%（T4），而常规护理组患病率保持稳定（从T0时 的57%降至T4时的50%）。与常规护理组相比，干预组在抑郁症状（F = 11.9；p = 0.001）、身体（F = 5.7；p = 0.018）和心理健康（F = 3.9；p = 0.047）以及生活质量（F = 21.8；p < 0.001）方面随时间有显著改善。在糖尿病患者、基线患有重度抑郁症的患者以及INTERMED评分为中度的患者中，效果往往更强。最后，干预组的住院次数较少，在随访的6至9个月期间达到统计学显著性（p = 0.02）。
结果表明，针对复杂内科疾病患者的精神科干预措施可改善健康结局。
