Hooper Lisa M, Epstein Steven A, Qu Lixin, Hannah Natalie J
University of Alabama, Tuscaloosa, AL, USA.
J Prim Care Community Health. 2011 Apr;2(2):107-15. doi: 10.1177/2150131910387647. Epub 2010 Dec 30.
Studies have long shown that some patients receive less than optimal care for depression in primary care settings. However, few studies have uncovered factors that predict and explain this deficiency. The authors administered a survey to 408 primary care physicians. They examined how physicians' attitudes (eg, feeling positively or negatively about treating depression in their patients), physicians' beliefs (eg, beliefs about what their patients think and prefer in terms of depression care), and demographic characteristics (independent variables) predicted optimal depression care (dependent variable). Using logistical regression analyses, they identified differences in treatment decisions between family and internal medicine physicians. Physicians' specialty and race (family physicians and white physicians were more likely to prescribe a medication) were unique determinants of whether the physician treated depression by prescribing medication; physicians' specialty and race (family physicians and nonwhite physicians were more likely to provide office-based counseling) were unique determinants of whether the physician treated depression by providing office-based counseling; physicians' beliefs about depression care and physician age were unique statistically significant determinants of whether the physician treated depression by providing a referral to a mental health specialist. These findings help clarify how physicians' specialty and beliefs about depression care influence treatment. In addition, the results in this study suggest that there are differences between family and internal medicine physicians in terms of their practice patterns and beliefs in types of treatment that patients would be willing to receive. Implications for future research on primary care depression treatment are discussed.
长期以来的研究表明，在初级保健机构中，一些抑郁症患者接受的治疗并不理想。然而，很少有研究发现能够预测和解释这种不足的因素。作者对408名初级保健医生进行了一项调查。他们研究了医生的态度（例如，对治疗患者抑郁症的积极或消极感受）、医生的信念（例如，对患者在抑郁症治疗方面的想法和偏好的信念）以及人口统计学特征（自变量）如何预测最佳抑郁症治疗（因变量）。通过逻辑回归分析，他们确定了家庭医生和内科医生在治疗决策上的差异。医生的专业和种族（家庭医生和白人医生更有可能开处方用药）是医生是否通过开处方用药治疗抑郁症的独特决定因素；医生的专业和种族（家庭医生和非白人医生更有可能提供基于办公室的咨询）是医生是否通过提供基于办公室的咨询治疗抑郁症的独特决定因素；医生对抑郁症治疗的信念和医生年龄是医生是否通过转介心理健康专家治疗抑郁症的具有统计学意义的独特决定因素。这些发现有助于阐明医生的专业和对抑郁症治疗的信念如何影响治疗。此外，本研究结果表明，家庭医生和内科医生在治疗模式以及对患者愿意接受的治疗类型的信念方面存在差异。文中还讨论了对未来初级保健抑郁症治疗研究的启示。
