Center for Evaluation and Sociomedical Research, Graduate School of Public Health, University of Puerto Rico, Medical Sciences Campus, P.O. Box 365067, San Juan, PR.
Psychiatr Serv. 2010 Feb;61(2):144-50. doi: 10.1176/ps.2010.61.2.144.
This study examined whether a collaborative care model for depression would improve clinical and functional outcomes for depressed patients with chronic general medical conditions in primary care practices in Puerto Rico.
A total of 179 primary care patients with major depression and chronic general medical conditions were randomly assigned to receive collaborative care or usual care. The collaborative care intervention involved enhanced collaboration among physicians, mental health specialists, and care managers paired with depression-specific treatment guidelines, patient education, and follow-up. In usual care, study personnel informed the patient and provider of the diagnosis and encouraged patients to discuss treatment options with their provider. Depression severity was assessed with the Hopkins Symptom Checklist; social functioning was assessed with the 36-item Short Form.
Compared with usual care, collaborative care significantly reduced depressive symptoms and improved social functioning in the six months after randomization. Integration of collaborative care in primary care practices considerably increased depressed patients' use of mental health services.
Collaborative care significantly improved clinical symptoms and functional status of depressed patients with coexisting chronic general medical conditions receiving treatment for depression in primary care practices in Puerto Rico. These findings highlight the promise of the collaborative care model for strengthening the relationship between mental health and primary care services in Puerto Rico.
本研究旨在考察针对抑郁障碍的协作式护理模式是否能够改善波多黎各初级保健实践中患有慢性躯体疾病的抑郁患者的临床和功能结局。
共有 179 名患有重度抑郁症和慢性躯体疾病的初级保健患者被随机分配至协作式护理组或常规护理组。协作式护理干预包括增强医生、精神科专家和护理经理之间的协作，并结合抑郁障碍特定的治疗指南、患者教育和随访。在常规护理中，研究人员向患者和医生告知了诊断结果，并鼓励患者与其医生讨论治疗方案。采用 Hopkins 症状清单评估抑郁严重程度，采用 36 项简短健康调查问卷评估社会功能。
与常规护理相比，协作式护理在随机分组后 6 个月时显著降低了抑郁症状，并改善了社会功能。将协作式护理融入初级保健实践显著增加了接受抑郁治疗的抑郁患者对精神卫生服务的利用。
协作式护理显著改善了在波多黎各初级保健实践中接受抑郁治疗的同时患有共存慢性躯体疾病的抑郁患者的临床症状和功能状态。这些发现突出了协作式护理模式在加强波多黎各精神卫生与初级保健服务之间关系方面的潜力。
