McCool Melissa, Johnstone Stephanie, Sledge Renata, Witten Beth, Contillo Michelle, Aebel-Groesch Kathryn, Hafner Jim
Fresenius Medical Care North America, San Diego, California, USA.
Nephrol News Issues. 2011 May;25(6):32-3, 35-7.
Research with tens of thousands of dialysis patients has established a link between depression, health-related quality of life scores, survival, and hospitalizations. In fact, physical and mental functioning scores are as predictive of death and hospitalization as Kt/V and albumin. Some models for managing depression in the dialysis clinic have been developed. These models address barriers to accessing community mental health services. They also promote collaboration between the nephrology social worker and nephrologist to assurethat patients receive counseling and/or antidepressant medications when they need them. Part 1 of this article will introduce a promising new method designed for nephrology social workers to help patients manage depression. This method, known as symptom-targeted intervention (STI), can be used in brief intervals with patients while they are receiving dialysis treatments to help reduce depressive symptoms and improve quality of life. The second part of this article, which will appear in the June issue of Nephrology News & Issues, will report the outcomes of a 17-state pilot study in which more than 45 nephrology social workers used brief, focused STI methods with more than 75 patients in the dialysis clinic setting. The impact of STI on depression and quality of life in this sample will be explored as well as how those outcomes may impact hospitalizations, improve patient survival, and contain costs in a bundled reimbursement environment.
针对数万名透析患者的研究已证实抑郁症、健康相关生活质量评分、生存率和住院率之间存在关联。事实上，身体和心理功能评分对死亡和住院的预测能力与尿素清除率（Kt/V）和白蛋白相当。目前已经开发出一些在透析诊所管理抑郁症的模式。这些模式解决了获得社区心理健康服务的障碍。它们还促进了肾脏科社会工作者和肾病科医生之间的合作，以确保患者在需要时能够获得咨询和/或抗抑郁药物。本文的第一部分将介绍一种为肾脏科社会工作者设计的、帮助患者管理抑郁症的有前景的新方法。这种方法称为症状靶向干预（STI），可在患者接受透析治疗时，以简短的间隔时间使用，以帮助减轻抑郁症状并提高生活质量。本文的第二部分将发表在《肾脏病新闻与问题》6月刊上，将报告一项在17个州进行的试点研究的结果，在该研究中，超过45名肾脏科社会工作者在透析诊所环境中对75多名患者使用了简短、有针对性的STI方法。将探讨STI对该样本中抑郁症和生活质量的影响，以及这些结果如何影响住院率、提高患者生存率，并在捆绑式报销环境中控制成本。
