Diagnosis and Treatment of Common Mental Disorders, Trimbos-Instituut/Netherlands Institute of Mental Health and Addiction, Utrecht, The Netherlands.
J Psychosom Res. 2010 Jun;68(6):521-33. doi: 10.1016/j.jpsychores.2009.10.012. Epub 2010 Jan 15.
Psychiatric consultation in primary care is meant to enhance and improve treatment for mental disorder in that setting. An estimate of the effect for different conditions as well as identification of particularly effective elements is needed.
Database search for randomized controlled trials (RCTs) on psychiatric consultation in primary care. Validity assessment and data extraction according to Cochrane criteria were performed by independent assessors in duplicate. Meta-analysis was performed.
Data were collected from 10 RCTs with a total of 3408 included patients with somatoform disorder or depressive disorder, which compared psychiatric consultation to care as usual (CAU). Meta-analysis irrespective of condition showed a weighted mean indicating a combined assessment of illness burden as outcome of psychiatric consultation, compared to CAU, of 0.313 (95% CI 0.190-0.437). The effect was especially large in somatoform disorder (0.614; 95% CI 0.206-1.022). RCTs in which after the consult, consultation advice was given by means of a consultation letter, showed a combined weighted mean effect size of 0.561 (95% CI 0.337-0.786), while studies not using such a letter showed a small effect of 0.210 (95% CI 0.102-0.319). Effects are highest on utilization of health care services with 0.507 (95% CI 0.305-0.708).
Psychiatric consultation in the primary care setting is effective in patients with somatoform and depressive disorder. Largest effects are seen in reduction of utilization of health care services.
初级保健中的精神科会诊旨在加强和改善该环境中的精神障碍治疗。需要评估不同情况下的效果，并确定特别有效的要素。
对初级保健中的精神科会诊的随机对照试验（RCT）进行数据库搜索。根据 Cochrane 标准，由独立评估员进行有效性评估和数据提取。进行了荟萃分析。
从 10 项 RCT 中收集了数据，共有 3408 名患有躯体形式障碍或抑郁障碍的患者参与，将精神科会诊与常规护理（CAU）进行了比较。荟萃分析显示，无论病情如何，与 CAU 相比，精神科会诊的加权平均值表明，作为精神科会诊结果的疾病负担的综合评估为 0.313（95%CI 0.190-0.437）。在躯体形式障碍中效果尤其明显（0.614；95%CI 0.206-1.022）。在咨询后通过咨询信提供咨询建议的 RCT 中，综合加权平均效应大小为 0.561（95%CI 0.337-0.786），而未使用此类信件的研究则显示出较小的效应，为 0.210（95%CI 0.102-0.319）。效果最高的是对卫生保健服务的利用，为 0.507（95%CI 0.305-0.708）。
初级保健环境中的精神科会诊对躯体形式障碍和抑郁障碍患者有效。最大的效果见于减少卫生保健服务的利用。
