Angstman Kurt B, Maclaughlin Kathy L, Williams Mark D, Rasmussen Norman H, Dejesus Ramona S
Department of Family Medicine, Mayo Clinic, Rochester, MN, USA.
J Prim Care Community Health. 2011 Apr;2(2):82-6. doi: 10.1177/2150131910387932. Epub 2010 Dec 30.
In 2008, the Institute for Clinical Systems Improvement (ICSI) in Minnesota implemented a model of collaborative care management (CCM) for treatment of depression in primary care. This resulted in significant improvements on both clinical response and remission over usual care, although an increase in utilization metrics has been observed. Mental health comorbidities have previously been significantly associated with an increased likelihood of not responding to initial treatment. This retrospective study hypothesized that patients with mental health comorbidities are more likely to be associated with patients who were readmitted into CCM with recurrent depression. A total of 145 patients who had completed CCM were studied; of these, 32 were diagnosed with recurrent depression and were readmitted to CCM, and 113 were in remission for at least 4 months. There were no statistically significant demographic differences between the 2 groups. The initial screening GAD-7 score for anxiety was significantly increased in the readmission group (12.81 vs 9.20, P = .001) as was the average length of treatment from initial diagnosis to remission (168.09 vs 120.99 days, P = .002). All other initial screening tests were not different between the groups. When controlling for the independent variables by multiple logistic regression, the odds ratio for GAD-7 was 1.1156 (CI = 1.0.192 to 1.2212, P = .0177) and for days of treatment in CCM was 1.0123 (CI = 1.0041 to 1.0206, P = .0033). Patients who are readmitted to CCM for recurrent depression have a statistically increased risk of associated anxiety and a longer treatment course than those who have remained in remission for at least 4 months.
2008年，明尼苏达州的临床系统改进研究所（ICSI）实施了一种协作式护理管理（CCM）模式，用于在初级护理中治疗抑郁症。这带来了相较于常规护理在临床反应和缓解方面的显著改善，尽管观察到了使用指标的增加。先前心理健康合并症与对初始治疗无反应的可能性增加显著相关。这项回顾性研究假设，患有心理健康合并症的患者更有可能与因复发性抑郁症再次进入CCM治疗的患者相关。总共对145名完成CCM治疗的患者进行了研究；其中，32名被诊断为复发性抑郁症并再次进入CCM治疗，113名处于缓解状态至少4个月。两组之间在人口统计学上没有显著差异。再次入院组的初始焦虑筛查GAD - 7评分显著升高（12.81对9.20，P = 0.001），从初始诊断到缓解的平均治疗时长也是如此（168.09对120.99天，P = 0.002）。两组之间所有其他初始筛查测试没有差异。通过多元逻辑回归控制自变量时，GAD - 7的优势比为1.1156（CI = 1.0192至1.2212，P = 0.0177），CCM治疗天数的优势比为1.0123（CI = 1.0041至1.0206，P = 0.0033）。因复发性抑郁症再次进入CCM治疗的患者与那些处于缓解状态至少4个月的患者相比，在统计学上患相关焦虑的风险增加，治疗疗程更长。
