College of Pharmacy, The University of Oklahoma, Tulsa, OK, USA.
Ann Pharmacother. 2013 Jun;47(6):797-804. doi: 10.1345/aph.1R730. Epub 2013 May 14.
Depression places a large economic burden on the US health care system. Routine screening has been recognized as a fundamental step in the effective treatment of depression, but should be undertaken only when support systems are available to ensure proper diagnosis, treatment, and follow-up.
To estimate differences in prescribing new antidepressants and referral to stress management, psychotherapy, and other mental health (OMH) counseling at physician visits when documented depression screening was and was not performed.
Cross-sectional physician visit data for adults from the 2005-2007 National Ambulatory Medical Care Survey were used. The final analytical sample included 55,143 visits, representing a national population estimate of 1,741,080,686 physician visits. Four dependent variables were considered: (1) order for new antidepressant(s), and referral to (2) stress management, (3) psycho therapy, or (4) OMH counseling. Bivariable and multivariable associations between depression screening and each measure of depression follow-up care were evaluated using the design-based F statistic and multivariable logistic regression models.
New antidepressant prescribing increased significantly (2.12% of visits without depression screening vs 10.61% with depression screening resulted in a new prescription of an antidepressant). Referral to stress management was the behavioral treatment with the greatest absolute change (3.31% of visits without depression screening vs 33.10% of visits with depression screening resulted in a referral to stress management). After controlling for background sociodemographic characteristics, the adjusted odds ratio of a new antidepressant order remained significantly higher at visits involving depression screening (AOR 5.36; 99.9% CI 2.92-9.82), as did referrals for all behavioral health care services (ie, stress management, psychotherapy, and OMH counseling).
At the national level, depression screening was associated with increased new antidepressant prescribing and referral for behavioral health care. It is critical for policy planners to recognize changes in follow-up depression care when implementing screening programs to ensure adequate capacity. Pharmacists are poised to assume a role in collaborative depression care, particularly with antidepressant medication therapy management.
抑郁症给美国医疗保健系统带来了巨大的经济负担。常规筛查已被认为是有效治疗抑郁症的基本步骤，但只有在有支持系统来确保正确诊断、治疗和随访的情况下，才应进行筛查。
评估在进行和未进行记录的抑郁症筛查时，在医生就诊时开具新的抗抑郁药和转介进行压力管理、心理治疗和其他心理健康（OMH）咨询方面的差异。
使用 2005-2007 年全国门诊医疗调查的成年患者的横断面医生就诊数据。最终分析样本包括 55143 次就诊，代表全国 1741080686 次医生就诊的估计人数。考虑了四个因变量：（1）新抗抑郁药的处方，以及（2）压力管理、（3）心理治疗或（4）OMH 咨询的转介。使用基于设计的 F 统计量和多变量逻辑回归模型评估抑郁症筛查与每种抑郁症随访护理措施之间的关联。
新的抗抑郁药处方显著增加（没有抑郁症筛查的就诊中，有 2.12%开了新的抗抑郁药处方，而有抑郁症筛查的就诊中，有 10.61%开了新的抗抑郁药处方）。压力管理转介是行为治疗中绝对变化最大的治疗方法（没有抑郁症筛查的就诊中，有 3.31%被转介进行压力管理，而有抑郁症筛查的就诊中，有 33.10%被转介进行压力管理）。在控制背景社会人口统计学特征后，在涉及抑郁症筛查的就诊中，新抗抑郁药处方的调整后比值比仍然显著更高（优势比 5.36；99.9%置信区间 2.92-9.82），所有行为健康护理服务（即压力管理、心理治疗和 OMH 咨询）的转介也如此。
在全国范围内，抑郁症筛查与新的抗抑郁药处方开具和行为健康护理转介增加相关。政策制定者在实施筛查计划时，必须认识到随访抑郁症护理的变化，以确保有足够的能力。药剂师准备在协作性抑郁症护理中发挥作用，特别是在抗抑郁药药物治疗管理方面。
