Health Services Research and Development, Central Arkansas Veterans Healthcare System, North Little Rock, AR; South Central Mental Illness Research Education and Clinical Center, Central Arkansas Veterans Healthcare System, North Little Rock, AR; Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR.
Gen Hosp Psychiatry. 2013 Sep-Oct;35(5):455-60. doi: 10.1016/j.genhosppsych.2013.04.010. Epub 2013 May 30.
Care management is feasible to deploy in routine care, and the depression outcomes of patients reached by this evidence-based practice are similar to those observed in randomized controlled trials. However, no studies have estimated the population level effectiveness of care management when deployed in routine care. Population level effectiveness depends on both reach into the target population and the clinical effectiveness for those reached.
This multisite hybrid Type 3 effectiveness-implementation study employed a pre-post, quasi-experimental design. The study was conducted at 22 Veterans Affairs community-based outpatient clinics. Evidence-based quality improvement was used as the facilitation strategy to promote adoption. Medication possession ratios (MPRs) were calculated for 1558 patients with an active antidepressant prescription. Differences in treatment response rates at implementation and control sites were estimated from observed differences in MPR.
Reach into the target population at implementation sites was 10.3%. Patients at implementation sites had a significantly higher probability of having MPR≥0.9 than patients at control sites [odds ratio=1.38, confidence interval95=(1.07, 1.78), P=.01]. This increase in MPR was estimated to yield a 1% point increase in response rates.
While depression care management improves outcomes for patients receiving services, low levels of reach can reduce overall population level effectiveness.
护理管理在常规护理中是可行的，并且通过这种基于证据的实践达到的患者抑郁结果与随机对照试验中观察到的结果相似。然而，尚无研究估计在常规护理中部署护理管理的人群水平效果。人群水平的效果取决于目标人群的覆盖范围以及对所覆盖人群的临床效果。
这项多地点混合 3 型有效性-实施研究采用了前后、准实验设计。该研究在 22 家退伍军人事务社区门诊进行。将循证质量改进作为促进采用的促进策略。为 1558 名正在服用抗抑郁药的患者计算了药物维持率 (MPR)。通过观察 MPR 的差异，从实施和对照地点的治疗反应率差异估计治疗效果。
实施地点的目标人群覆盖率为 10.3%。与对照组相比，实施点的患者 MPR≥0.9 的可能性显著更高[优势比=1.38，95%置信区间=（1.07，1.78），P=.01]。这种 MPR 的增加估计会使反应率提高 1 个百分点。
虽然抑郁护理管理改善了接受服务的患者的结果，但低水平的覆盖率会降低整体人群水平的效果。
