Depression Clinical and Research Program, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.
Depress Anxiety. 2012 Oct;29(10):865-73. doi: 10.1002/da.21983. Epub 2012 Jul 16.
Despite the availability of effective treatments for depression, many patients under the care of primary care physicians do not achieve remission. Clinical Outcomes in Measurement-based Treatment (COMET) was designed to assess whether communicating patient-reported depression symptom severity to primary care physicians affects patient outcomes at 6 months.
Nine hundred fifteen patients (intervention: n = 503; control: n = 412) diagnosed with major depressive disorder were enrolled in a prospective trial in which physician practice sites were assigned to either the intervention or control study arm. Only patients who were prescribed an antidepressant by their physician were eligible, but medication type was independent of the study protocol. Intervention-arm physicians received monthly updates on their patients' depression severity, which was determined with the nine-item Patient Health Questionnaire (PHQ-9) administered during telephone interviews. Remission was defined as a PHQ-9 score <5 at 6 months; response was defined as a score reduction ≥50%.
Among patients with baseline PHQ-9 score ≥5, 45.0% achieved remission (46.7% intervention versus 42.8% control) and 63.9% responded (67.0% intervention versus 59.7% control) at 6 months. After adjusting for baseline demographic and clinical variables, odds of remission (odds ratio [OR], 1.59 [95% CI, 1.07-2.37]) or response (OR, 2.02 [95% CI, 1.36-3.02]) were significantly greater for the intervention group than for control patients.
This study demonstrated that regular patient symptom monitoring with feedback to physicians improved outcomes of depression treatment in the primary care setting. Determining reasons for the high observed nonremission rates requires further investigation.
尽管有许多有效的抑郁症治疗方法，但许多在初级保健医生护理下的患者并未达到缓解。基于患者报告的测量治疗的临床结果（COMET）旨在评估向初级保健医生传达患者报告的抑郁症状严重程度是否会影响 6 个月时的患者结果。
915 名被诊断为重度抑郁症的患者（干预组：n = 503；对照组：n = 412）参加了一项前瞻性试验，根据医生的实践地点将其分配到干预组或对照组研究臂。只有经医生开处方抗抑郁药的患者有资格参加，但药物类型与研究方案无关。干预组的医生每月都会收到患者抑郁严重程度的更新，这是通过电话访谈中使用的 9 项患者健康问卷（PHQ-9）来确定的。缓解定义为 6 个月时 PHQ-9 评分<5；反应定义为评分降低≥50%。
在基线 PHQ-9 评分≥5 的患者中，有 45.0%达到缓解（干预组为 46.7%，对照组为 42.8%），63.9%有反应（干预组为 67.0%，对照组为 59.7%）在 6 个月时。调整基线人口统计学和临床变量后，与对照组相比，干预组缓解（优势比[OR]，1.59 [95%置信区间，1.07-2.37]）或反应（OR，2.02 [95%置信区间，1.36-3.02]）的可能性更大。
这项研究表明，定期对患者症状进行监测并向医生提供反馈可改善初级保健环境中抑郁症治疗的结果。需要进一步调查确定观察到的高未缓解率的原因。
