Garrison Gregory M, Angstman Kurt B, O'Connor Stephen S, Williams Mark D, Lineberry Timothy W
From the Department of Family Medicine (GMG, KBA) and the Department of Psychiatry & Psychology (MDW), Mayo Clinic, Rochester, MN; and the Department of Psychological Sciences, Western Kentucky University, Bowling Green, KY (SSO); Aurora Health Care, Green Bay, WI (TWL).
J Am Board Fam Med. 2016 Jan-Feb;29(1):10-7. doi: 10.3122/jabfm.2016.01.150128.
Collaborative care management (CCM) has been shown to have superior outcomes to usual care (UC) for depressed patients with a fixed end point. This study was a survival analysis over time comparing CCM with UC using remission (9-item Patient Health Questionnaire [PHQ-9] score <5) and persistent depressive symptoms (PDSs; PHQ-9 score ≥10) as end points.
A retrospective cohort study of 7340 patients with depression cared for at 4 outpatient primary care clinics was conducted from March 2008 through June 2013. All adult patients diagnosed with depression (International Classification of Diseases, 9th Revision [ICD-9], codes 296.2-3) or dysthymia (ICD-9 code 300.4) with an initial PHQ-9 score ≥10 were included. CCM was implemented at all clinics between 2008 and 2010. Kaplan-Meyer survival curves for time to remission and PDSs were plotted. A Cox proportional hazards model was used to adjust for expected differences between patients choosing CCM versus UC.
Median time to remission was 86 days (95% confidence interval [CI], 81-91 days) for the CCM group versus 614 days (95% CI, 565-692 days) for the UC group. Likewise, median duration of PDSs was 31 days (95% CI, 30-33 days) for the CCM group versus 154 days (95% CI, 138-182 days) for the UC group. In the Cox proportional hazards model, which controlled for covariates such as age, sex, race, diagnosis, and initial PHQ-9 score, CCM was associated with faster remission (hazard ratio of the CCM group [HRCCM], 2.48; 95% CI, 2.31-2.65).
This study demonstrated that patients enrolled in CCM have a faster rate of remission and a shorter duration of PDSs than patients choosing UC.
对于有固定终点的抑郁症患者，协作式护理管理（CCM）已被证明比常规护理（UC）具有更好的治疗效果。本研究是一项随时间进行的生存分析，将CCM与UC进行比较，以缓解（9项患者健康问卷[PHQ - 9]评分<5）和持续性抑郁症状（PDSs；PHQ - 9评分≥10）作为终点。
对2008年3月至2013年6月期间在4家门诊基层医疗诊所接受治疗的7340例抑郁症患者进行回顾性队列研究。纳入所有初始PHQ - 9评分≥10且被诊断为抑郁症（国际疾病分类第9版[ICD - 9]，编码296.2 - 3）或心境恶劣（ICD - 9编码300.4）的成年患者。2008年至2010年期间，所有诊所均实施了CCM。绘制了达到缓解和出现PDSs时间的Kaplan - Meyer生存曲线。使用Cox比例风险模型对选择CCM与UC的患者之间的预期差异进行调整。
CCM组达到缓解的中位时间为86天（95%置信区间[CI]，81 - 91天），而UC组为614天（95%CI，565 - 692天）。同样，CCM组PDSs的中位持续时间为31天（95%CI，30 - 33天），UC组为154天（95%CI，138 - 182天）。在控制了年龄、性别、种族、诊断和初始PHQ - 9评分等协变量的Cox比例风险模型中，CCM与更快的缓解相关（CCM组的风险比[HRCCM]，2.48；95%CI，2.31 - 2.65）。
本研究表明，与选择UC的患者相比，参与CCM的患者缓解速度更快，PDSs持续时间更短。
