Research Centre for Old Age Psychiatry, Innlandet Hospital Trust, 2312 Ottestad, Norway.
Epidemiol Psychiatr Sci. 2012 Sep;21(3):237-40. doi: 10.1017/S204579601200025X. Epub 2012 May 22.
Depression in the elderly is common and exhibits a distinctive phenomenology, due to neurobiological, physiological, psychological and social changes related to ageing. Most elderly with depression are managed in primary health care. Although the number of scientific publications related to geriatric psychiatry has increased, there are still important gaps. Implementation of evidence-based guidelines for managing depression in primary care has had limited success, but has led to improvements compared to standard care. It is logical that the determinants (barriers and enablers) of implementing depression guidelines can be identified and can guide the selection of more effective implementation strategies that are tailored to address those determinants. We are testing that logic as part of a multinational implementation research project called 'Tailored Implementation for Chronic Diseases' (TICD). Our focus in Norway is on the management of depression in the elderly in primary care. We will identify the determinants of implementing evidence-based recommendations using various methods and comparing those methods. We will then use different methods to match the implementation interventions to the identified determinants and compare those methods. Finally, we will evaluate the resulting tailored implementation strategy in a randomized trial.
老年人抑郁症很常见，其表现出独特的现象学特征，这与与衰老相关的神经生物学、生理学、心理学和社会变化有关。大多数患有抑郁症的老年人都在初级保健中得到管理。尽管与老年精神病学相关的科学出版物数量有所增加，但仍存在重要差距。在初级保健中实施管理抑郁症的循证指南的效果有限，但与标准护理相比有所改善。合乎逻辑的是，可以确定实施抑郁症指南的决定因素（障碍和促进因素），并可以指导选择更有效的实施策略，这些策略可以针对这些决定因素进行调整。我们正在作为一个名为“慢性病定制实施”（TICD）的跨国实施研究项目的一部分来检验这一逻辑。我们在挪威的重点是在初级保健中管理老年人的抑郁症。我们将使用各种方法确定实施循证建议的决定因素，并对这些方法进行比较。然后，我们将使用不同的方法将实施干预措施与确定的决定因素相匹配，并对这些方法进行比较。最后，我们将在随机试验中评估由此产生的定制实施策略。
