Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA 90024, USA.
Psychiatr Serv. 2009 Nov;60(11):1460-2. doi: 10.1176/appi.ps.60.11.1460.
The Sequenced Treatment Alternatives to Relieve Depression (STARD) trial found that after initial treatment, depressed patients treated in primary care settings had the same or slightly better outcomes than those treated in specialty care settings. The authors describe challenges to using the STARD approach and protocols in usual primary care settings. These include inadequate availability of appointments, insufficient resources for care management and treatment monitoring, and lack of payment to primary care providers for providing mental health care. Substantial reengineering of payment and delivery systems is needed in order for the STAR*D approach to be viable in primary care clinics.
序列治疗选择缓解抑郁（STARD）试验发现，在初始治疗后，在初级保健环境中治疗的抑郁患者的治疗结果与在专科保健环境中治疗的患者相同或略好。作者描述了在常规初级保健环境中使用 STARD 方法和方案所面临的挑战。这些挑战包括预约机会不足，护理管理和治疗监测资源不足，以及为初级保健提供者提供精神保健服务的支付不足。为了使 STAR*D 方法在初级保健诊所可行，需要对支付和交付系统进行重大改革。
