Angstman Kurt B, Meunier Matthew R, Rohrer James E, Oberhelman Sara S, Maxson Julie A, Rahman Parvez A S
Mayo Clinic, Rochester, MN, USA.
J Prim Care Community Health. 2014 Jan 1;5(1):30-5. doi: 10.1177/2150131913511465. Epub 2013 Nov 25.
The inclusion of mental health issues in the evaluation of multimorbidity generally has been as the presence or absence of the condition rather than severity, complexity, or stage. The hypothesis for this study was that clinical outcome of the depression 6 months after enrollment into collaborative care management would have a role in predicting future complexity of care tier.
This study was a retrospective chart review of 1894 primary care patients who were diagnosed with major depressive disorder or dysthymia as of December 2012. Multiple logistic regression analysis was used to test the independent associations between each variable and the odds of being included in the higher tiers (HT) group.
Age (odds ratio [OR] = 1.022, confidence interval [CI] = 1.013-1.030, P < .001), female gender (OR = 1.380, CI = 1.020-1.868, P = .037), being married (OR = 0.730, CI = 0.563-0.947, P = .018), and the presence of comorbidities (1, OR = 1.986, CI = 1.485-2.656, P < .001; ≥ 2, OR = 4.678, CI = 3.242-6.750, P < .001) were independently associated with future HT levels. The presence of persistent depressive symptoms (PHQ-9 ≥ 10) at 6 months conferred 2.280 (CI = 1.673-3.107, P < .001) times likely odds of HT level compared with clinical remission at 6 months.
Patients with the diagnosis of major depression or dysthymia had greater odds of complex tier levels in the future, if depression was not treated to remission by 6 months. This study demonstrated the importance of the goal of significant improvement (ie, remission) of depression symptoms by 6 months (especially those older patients with more comorbidity) from entering into the higher complexity tiers.
在评估多种疾病共病时，心理健康问题通常仅被视为该疾病是否存在，而非其严重程度、复杂性或阶段。本研究的假设是，纳入协作式护理管理6个月后的抑郁症临床结局，将对预测未来护理层级的复杂性起到作用。
本研究是一项回顾性病历审查，研究对象为截至2012年12月被诊断患有重度抑郁症或心境恶劣障碍的1894名初级护理患者。采用多元逻辑回归分析来检验每个变量与被纳入更高层级（HT）组的几率之间的独立关联。
年龄（比值比[OR]=1.022，置信区间[CI]=1.013 - 1.030，P<.001）、女性（OR = 1.380，CI = 1.020 - 1.868，P = .037）、已婚（OR = 0.730，CI = 0.563 - 0.947，P = .018）以及存在共病（1种，OR = 1.986，CI = 1.485 - 2.656，P<.001；≥2种，OR = 4.678，CI = 3.242 - 6.750，P<.001）与未来的HT水平独立相关。与6个月时临床缓解相比，6个月时存在持续性抑郁症状（患者健康问卷-9[PHQ-9]≥10）的患者处于HT层级的几率高2.280倍（CI = 1.673 - 3.107，P<.001）。
如果重度抑郁症或心境恶劣障碍患者在6个月时抑郁症未治疗至缓解，那么其未来处于复杂护理层级的几率更高。本研究表明，对于进入更高复杂性护理层级而言，在6个月时（尤其是那些患有更多共病的老年患者）使抑郁症状显著改善（即缓解）这一目标具有重要意义。
