Elwy A Rani, Glickman Mark E, Bokhour Barbara G, Dell Natalie S, Mueller Nora M, Zhao Shibei, Osei-Bonsu Princess E, Rodrigues Stephanie, Coldwell Craig M, Ngo Tu A, Schlosser James, Vielhauer Melanie J, Pirraglia Paul A, Eisen Susan V
*Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial VA Hospital, Bedford †Department of Health Policy and Management, Boston University School of Public Health, Boston ‡Department of Psychiatry, UMass Memorial Medical Center, University Campus, Worcester §Department of Psychiatry, Boston University School of Medicine, VA New England Healthcare System, Bedford, MA ∥Psychology Service, Edith Nourse Rogers Memorial VA Hospital, Bedford ¶General Mental Health Service, VA Boston Healthcare System #Department of Psychiatry, Boston University School of Medicine **Primary Care Service, Providence VA Medical Center, Providence, RI, Boston, MA.
Med Care. 2016 Jun;54(6):e35-42. doi: 10.1097/MLR.0000000000000056.
Although depression screening occurs annually in the Department of Veterans Affairs (VA) primary care, many veterans may not be receiving guideline-concordant depression treatment.
To determine whether veterans' illness perceptions of depression may be serving as barriers to guideline-concordant treatment.
We used a prospective, observational design involving a mailed questionnaire and chart review data collection to assess depression treatment utilization and concordance with Healthcare Effectiveness Data and Information Set guidelines adopted by the VA. The Self-Regulation Model of Illness Behavior guided the study.
Veterans who screened positive for a new episode of depression at 3 VA primary care clinics in the US northeast.
The Illness Perceptions Questionnaire-Revised, measuring patients' perceptions of their symptoms, cause, timeline, consequences, cure or controllability, and coherence of depression and its symptoms, was our primary measure to calculate veterans' illness perceptions. Treatment utilization was assessed 3 months after the positive depression screen through chart review. Healthcare Effectiveness Data and Information Set (HEDIS) guideline-concordant treatment was determined according to a checklist created for the study.
A total of 839 veterans screened positive for a new episode of depression from May 2009-June 2011; 275 (32.8%) completed the survey. Ninety-two (33.9%) received HEDIS guideline-concordant depression treatment. Veterans' illness perceptions of their symptoms, cause, timeline, and controllability of depression predicted receiving guideline-concordant treatment.
Many veterans are not receiving guideline-concordant treatment for depression. HEDIS guideline measures may not be assessing all aspects of quality depression care. Conversations about veterans' illness perceptions and their specific needs are encouraged to ensure that appropriate treatment is achieved.
尽管美国退伍军人事务部（VA）的初级保健部门每年都会进行抑郁症筛查，但许多退伍军人可能并未接受符合指南的抑郁症治疗。
确定退伍军人对抑郁症的疾病认知是否成为符合指南治疗的障碍。
我们采用了前瞻性观察设计，通过邮寄问卷和病历审查数据收集来评估抑郁症治疗的利用率以及与VA采用的医疗保健有效性数据和信息集指南的一致性。疾病行为的自我调节模型指导了该研究。
在美国东北部3家VA初级保健诊所中，新发作抑郁症筛查呈阳性的退伍军人。
我们的主要测量方法是使用修订后的疾病认知问卷，该问卷用于测量患者对其症状、病因、病程、后果、治愈或可控性以及抑郁症及其症状的连贯性的认知，以此来计算退伍军人的疾病认知。通过病历审查在抑郁症筛查呈阳性3个月后评估治疗利用率。根据为该研究创建的检查表确定符合医疗保健有效性数据和信息集（HEDIS）指南的治疗。
2009年5月至2011年6月期间，共有839名退伍军人新发作抑郁症筛查呈阳性；275名（32.8%）完成了调查。92名（33.9%）接受了符合HEDIS指南的抑郁症治疗。退伍军人对其抑郁症症状、病因、病程和可控性的疾病认知预测了其接受符合指南的治疗情况。
许多退伍军人未接受符合指南的抑郁症治疗。HEDIS指南措施可能未评估抑郁症优质护理的所有方面。鼓励就退伍军人的疾病认知及其特定需求进行对话，以确保实现适当治疗。
