基层医疗中的抑郁管理：一项观察性研究，旨在探讨 PHQ-9 评分与抑郁监测管理变化的关系。
Depression management in primary care: an observational study of management changes related to PHQ-9 score for depression monitoring.
机构信息
Primary and Population Science, University of Southampton, Southampton, UK.
出版信息
Br J Gen Pract. 2012 Jun;62(599):e451-7. doi: 10.3399/bjgp12X649151.
BACKGROUND
Since 2009 UK GPs have been incentivised to use depression severity scores to monitor patients' response to treatment after 5-12 weeks of treatment.
AIM
To examine the association between the severity scores obtained and follow-up questionnaires to monitor depression and subsequent changes made to the treatment of it.
DESIGN AND SETTING
A retrospective cohort study utilising routine primary care records was conducted between April 2009 and March 2011 in 13 general practices recruited from within Hampshire, Wiltshire, and Southampton City primary care trusts.
METHOD
Records were examined of 604 patients who had received a new diagnosis of depression since 1 April 2009, and who had completed the nine-item depression scale of the Patient Health Questionnaire (PHQ-9) at initial diagnosis and a subsequent PHQ-9 within 6 months. The main outcome measure was the odds ratio (OR) for a change in depression management. Change in management was defined as change in antidepressant drug prescription, dose, or referral.
RESULTS
Controlling for the effects of potentially confounding factors, patients who showed an inadequate response in score change at the time of second assessment were nearly five times as likely to experience a subsequent change to treatment in comparison with those who showed an adequate response (OR 4.72, 95% confidence interval = 2.83 to 7.86).
CONCLUSION
GPs' decisions to change treatment or to make referrals following a second PHQ-9 appear to be in line with guidance from the National Institute for Health and Clinical Excellence for the monitoring of depression in primary care. Although the present study demonstrates an association between a lack of change in questionnaire scores and treatment changes, the extent to which scores influence choice and whether they are associated with improvements in depression outcomes is an important area for further research.
背景
自 2009 年以来，英国全科医生（GP）一直受到激励，使用抑郁严重程度评分来监测患者在治疗 5-12 周后的治疗反应。
目的
检查所获得的严重程度评分与监测抑郁的后续问卷之间的关联，以及随后对其治疗的改变。
设计和设置
这是一项回顾性队列研究，利用常规初级保健记录，于 2009 年 4 月至 2011 年 3 月期间在汉普郡、威尔特郡和南安普顿市初级保健信托的 13 家普通实践中进行。
方法
对自 2009 年 4 月 1 日以来接受新诊断为抑郁症的 604 名患者的记录进行了检查，这些患者在初次诊断时完成了九项患者健康问卷（PHQ-9），并且在 6 个月内完成了另一项 PHQ-9。主要结局测量是管理变化的优势比（OR）。管理的变化定义为抗抑郁药物处方、剂量或转介的变化。
结果
在控制可能混杂因素的影响后，在第二次评估时评分变化显示无明显反应的患者与显示有明显反应的患者相比，后续治疗改变的可能性几乎是前者的五倍（OR 4.72，95%置信区间= 2.83 至 7.86）。
结论
GP 决定在第二次 PHQ-9 后改变治疗或转介，似乎符合国家卫生与临床优化研究所（NICE）对初级保健中抑郁监测的指导。尽管本研究表明问卷评分无变化与治疗变化之间存在关联，但评分在多大程度上影响选择以及它们是否与抑郁结局的改善相关，这是一个重要的研究领域。
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