Department of Veterans Affairs (VA) Butler VA Medical Center, 325 New Castle Rd., Butler, PA 16001, USA.
Psychiatr Serv. 2010 Nov;61(11):1126-31. doi: 10.1176/ps.2010.61.11.1126.
Although depression screening in primary care is recommended by the U.S. Preventive Services Task Force, it may increase the duration of primary care physician visits that are often at or exceeding capacity. This study was conducted to evaluate the relationship between depression screening and physician visit duration in community-based, primary care physician office visits while controlling for important covariates.
Cross-sectional data from the 2005-2007 National Ambulatory Medical Care Survey were used to examine the relationship between physician-indicated depression screening and office visit duration among adults (≥18 years of age) with multivariable, ordered logistic regression. Predicted probabilities of visit duration (by 15-minute increments of one to 15, 16-30, 31-45, and 46-60 minutes) were estimated for visits where depression screening was and was not documented.
In a sample of 14,736 physician office visits, representing an estimated population of more than 641 million visits, depression screening was significantly associated with increased visit duration (adjusted odds ratio=3.66, 95% confidence interval=2.25-5.95). A prominent shift in the proportion of visits that were from one to 15 minutes long to visits that were at least 16-30 minutes long was observed when depression screening was documented.
Depression screening may increase the duration of physician visits. Given demands on physicians' time, the impact of increased depression screening, including the costs and benefits of using alternative methods and technologies to reduce physician time burden associated with depression screening, should be evaluated.
尽管美国预防服务工作组推荐在初级保健中进行抑郁症筛查,但这可能会延长初级保健医生的就诊时间,而这些就诊时间往往已经达到或超过了医生的接诊能力。本研究旨在评估在控制重要协变量的情况下,社区初级保健医生就诊中抑郁症筛查与就诊时间之间的关系。
使用 2005-2007 年全国门诊医疗调查的横断面数据,采用多变量有序逻辑回归,检验成年患者(≥18 岁)中医生提示的抑郁症筛查与就诊时间之间的关系。对记录有和未记录有抑郁症筛查的就诊,分别估计就诊时间(以 15 分钟为增量,从 1 到 15、16-30、31-45 和 46-60 分钟)的预测概率。
在 14736 次医生门诊就诊中,估计代表超过 6.41 亿次就诊的人群,抑郁症筛查与就诊时间延长显著相关(调整后的优势比=3.66,95%置信区间=2.25-5.95)。当记录有抑郁症筛查时,观察到就诊时间从 1 到 15 分钟的比例显著向至少 16-30 分钟的比例转移。
抑郁症筛查可能会延长医生的就诊时间。鉴于对医生时间的需求,应评估增加抑郁症筛查的影响,包括使用替代方法和技术来减少与抑郁症筛查相关的医生时间负担的成本和收益。