Duffy Farifteh Firoozmand, Chung Henry, Trivedi Madhukar, Rae Donald S, Regier Darrel A, Katzelnick David J
American Psychiatric Institutefor Research and Education, Arlington, VA 22209, USA.
Psychiatr Serv. 2008 Oct;59(10):1148-54. doi: 10.1176/ps.2008.59.10.1148.
The gap between evidence-based treatments and routine care has been well established. Findings from the Sequenced Treatments Alternatives to Relieve Depression (STAR*D) emphasized the importance of measurement-based care for the treatment of depression as a key ingredient for achieving response and remission; yet measurement-based care approaches are not commonly used in clinical practice.
The Nine-Item Patient Health Questionnaire (PHQ-9) for monitoring depression severity was introduced in 19 diverse psychiatric practices. During the one-year course of the project the helpfulness and feasibility of implementation of PHQ-9 in these psychiatric practices were studied. The project was modeled after the Institute for Healthcare Improvement Breakthrough Series. Two of the 19 practices dropped out during the course of the project.
By the conclusion of the study, all remaining 17 practices had adopted PHQ-9 as a routine part of depression care in their practice. On the basis of responses from 17 psychiatrists from those practices, PHQ-9 scores influenced clinical decision making for 93% of 6,096 patient contacts. With the additional information gained from the PHQ-9 score, one or more treatment changes occurred during 40% of these clinical contacts. Changing the dosage of antidepressant medication and adding another medication were the most common treatment changes recorded by psychiatrists, followed by starting or increasing psychotherapy and by switching or initiating antidepressants. In 3% of the patient contacts, using the PHQ-9 led to additional suicide risk assessment.
The study findings suggest that adopting measurement-based care, such as using the PHQ-9, is achievable, even in practices with limited resources.
循证治疗与常规护理之间的差距已得到充分证实。缓解抑郁症的序贯治疗替代方案（STAR*D）的研究结果强调了基于测量的护理对于抑郁症治疗的重要性，这是实现缓解和痊愈的关键因素；然而，基于测量的护理方法在临床实践中并不常用。
在19个不同的精神科诊所引入了用于监测抑郁严重程度的九项患者健康问卷（PHQ - 9）。在该项目为期一年的过程中，研究了在这些精神科诊所实施PHQ - 9的有效性和可行性。该项目仿照医疗保健改进研究所的突破系列进行。在项目过程中，19个诊所中有2个退出。
到研究结束时，所有剩余的17个诊所都已将PHQ - 9作为其抑郁症护理的常规组成部分。根据这些诊所的17位精神科医生的反馈，在6096次患者接触中，93%的接触中PHQ - 9评分影响了临床决策。利用从PHQ - 9评分中获得的额外信息，在40%的这些临床接触过程中发生了一项或多项治疗调整。精神科医生记录的最常见治疗调整是改变抗抑郁药物的剂量和添加另一种药物，其次是开始或增加心理治疗以及更换或开始使用抗抑郁药。在3%的患者接触中，使用PHQ - 9导致了额外的自杀风险评估。
研究结果表明，即使在资源有限的诊所，采用基于测量的护理，如使用PHQ - 9，也是可行的。
