Glasser Michael, Vogels Lieke, Gravdal Judith
National Center for Rural Health Professions, Rockford, Illinois, USA.
Rural Remote Health. 2009 Oct-Dec;9(4):1180. Epub 2009 Nov 17.
Depression is the fourth leading cause of the global disease burden, and approximately one in four elderly people may suffer from depression or depressive symptoms. Depression in later life is generally regarded as highly treatable, but under-treatment is still common in this population, especially among those in rural areas where access to healthcare is often an issue. In this study rural primary care physicians' practices, attitudes, barriers and perceived needs in the diagnosis and treatment of geriatric depression were described, and trends in care delivery examined.
A survey was sent to 162 rural Illinois family physicians and general internists. The survey focused on current practices, attitudes and perceptions regarding geriatric depression, barriers to and needs for improvement in depression care and physician and practice characteristics.
Seventy-six physicians (47%) responded. The rural physicians indicated that over one-third of their patients aged 60 years and older were depressed. All reported routine screening for depression, with 24% using the Beck Depression Inventory. Overall, physicians expressed positive attitudes about their involvement in treating older depressed patients. However, 45% indicated a 'gap' between ideal and available care in their rural practices. Physicians with higher proportions of elderly patients in their panels were more likely to feel that more training in residency in geriatric care would be helpful in improving care, and that better availability of psychologists and counselors would be important for improvement of care for older, depressed patients.
This study responds to recent calls to better understand how primary care physicians diagnose and treat depression in older adults. Generally, primary care physicians appear comfortable and prepared in depression diagnosis and management, but factors such as availability of appropriate care remain a challenge.
抑郁症是全球疾病负担的第四大主要原因，约四分之一的老年人可能患有抑郁症或抑郁症状。晚年抑郁症通常被认为是高度可治的，但在这一人群中治疗不足仍然很常见，尤其是在农村地区，那里获得医疗保健往往是个问题。本研究描述了农村基层医疗医生在老年抑郁症诊断和治疗方面的做法、态度、障碍和感知需求，并研究了护理提供的趋势。
向伊利诺伊州162名农村家庭医生和普通内科医生发送了一份调查问卷。该调查聚焦于当前关于老年抑郁症的做法、态度和认知、抑郁症护理改善的障碍和需求以及医生和诊所特征。
76名医生（47%）回复了问卷。农村医生表示，他们60岁及以上的患者中有超过三分之一患有抑郁症。所有医生都报告进行抑郁症的常规筛查，其中24%使用贝克抑郁量表。总体而言，医生对参与治疗老年抑郁症患者持积极态度。然而，45%的医生表示，他们在农村诊所的理想护理和实际可提供的护理之间存在“差距”。其患者群体中老年人比例较高的医生更有可能认为，在老年护理住院医师培训中接受更多培训有助于改善护理，并且更好地提供心理医生和咨询师对改善老年抑郁症患者的护理很重要。
本研究回应了最近关于更好地了解基层医疗医生如何诊断和治疗老年人抑郁症的呼吁。总体而言，基层医疗医生在抑郁症诊断和管理方面似乎得心应手且有所准备，但诸如适当护理的可及性等因素仍然是一个挑战。
