Group Health Research Institute, 1730 Minor Ave, #1600, Seattle, WA 98101, USA.
J Gen Intern Med. 2011 Jul;26(7):698-704. doi: 10.1007/s11606-011-1679-8. Epub 2011 Mar 8.
Quality of antidepressant treatment remains disturbingly poor. Rates of medication adherence and follow-up contact are especially low in primary care, where most depression treatment begins. Telephone care management programs can address these gaps, but reliance on live contact makes such programs less available, less timely, and more expensive.
Evaluate the feasibility, acceptability, and effectiveness of a depression care management program delivered by online messaging through an electronic medical record.
Randomized controlled trial comparing usual primary care treatment to primary care supported by online care management
Nine primary care clinics of an integrated health system in Washington state
Two hundred and eight patients starting antidepressant treatment for depression.
Three online care management contacts with a trained psychiatric nurse. Each contact included a structured assessment (severity of depression, medication adherence, side effects), algorithm-based feedback to the patient and treating physician, and as-needed facilitation of follow-up care. All communication occurred through secure, asynchronous messages within an electronic medical record.
An online survey approximately five months after randomization assessed the primary outcome (depression severity according to the Symptom Checklist scale) and satisfaction with care, a secondary outcome. Additional secondary outcomes (antidepressant adherence and use of health services) were assessed using computerized medical records.
Patients offered the program had higher rates of antidepressant adherence (81% continued treatment more than 3 months vs. 61%, p = 0.001), lower Symptom Checklist depression scores after 5 months (0.95 vs. 1.17, p = 0.043), and greater satisfaction with depression treatment (53% "very satisfied" vs. 33%, p = 0.004).
The trial was conducted in one integrated health care system with a single care management nurse. Results apply only to patients using online messaging.
Our findings suggest that organized follow-up care for depression can be delivered effectively and efficiently through online messaging.
抗抑郁治疗的质量仍然很差。在大多数抑郁症治疗开始的初级保健中，药物依从性和随访联系率特别低。电话护理管理计划可以解决这些差距，但依赖于实时联系，使得这些计划不太可用、不太及时且成本更高。
评估通过电子病历在线消息传递提供的抑郁症护理管理计划的可行性、可接受性和有效性。
比较常规初级保健治疗和在线护理管理支持的初级保健的随机对照试验
华盛顿州综合卫生系统的 9 个初级保健诊所
208 名开始抗抑郁治疗的抑郁症患者。
与经过培训的精神科护士进行 3 次在线护理管理联系。每次联系都包括结构化评估（抑郁严重程度、药物依从性、副作用）、基于算法的反馈给患者和治疗医生，以及根据需要促进后续护理。所有沟通都是通过电子病历中的安全、异步消息进行的。
随机分组后大约五个月进行在线调查，评估主要结果（根据症状检查表量表评估的抑郁严重程度）和护理满意度，这是次要结果。使用计算机化医疗记录评估其他次要结果（抗抑郁药物依从性和使用卫生服务）。
提供该计划的患者抗抑郁药物的依从性更高（81%继续治疗超过 3 个月，而 61%，p = 0.001），5 个月后症状检查表抑郁评分更低（0.95 与 1.17，p = 0.043），对抑郁症治疗的满意度更高（53%“非常满意”，而 33%，p = 0.004）。
该试验仅在一个综合医疗保健系统中进行，由一名护理管理护士进行。结果仅适用于使用在线消息传递的患者。
我们的发现表明，通过在线消息传递可以有效地提供有组织的抑郁症随访护理。
