Bishop Tara F, Ramsay Patricia P, Casalino Lawrence P, Bao Yuhua, Pincus Harold A, Shortell Stephen M
Tara F. Bishop (
Patricia P. Ramsay is a research specialist and administrative director of the Center for Healthcare Organizational and Innovation Research (CHOIR) in the School of Public Health, University of California, Berkeley.
Health Aff (Millwood). 2016 Mar;35(3):394-400. doi: 10.1377/hlthaff.2015.1068.
Primary care physicians play an important role in the diagnosis and management of depression. Yet little is known about their use of care management processes for depression. Using national survey data for the period 2006-13, we assessed the use of five care management processes for depression and other chronic illnesses among primary care practices in the United States. We found significantly less use for depression than for asthma, congestive heart failure, or diabetes in 2012-13. On average, practices used fewer than one care management process for depression, and this level of use has not changed since 2006-07, regardless of practice size. In contrast, use of diabetes care management processes has increased significantly among larger practices. These findings may indicate that US primary care practices are not well equipped to manage depression as a chronic illness, despite the high proportion of depression care they provide. Policies that incentivize depression care management, including additional quality metrics, should be considered.
基层医疗医生在抑郁症的诊断和管理中发挥着重要作用。然而，对于他们在抑郁症护理管理流程方面的应用情况，人们知之甚少。利用2006 - 2013年期间的全国调查数据，我们评估了美国基层医疗机构针对抑郁症及其他慢性疾病所采用的五种护理管理流程。我们发现，在2012 - 2013年期间，抑郁症护理管理流程的应用显著少于哮喘、充血性心力衰竭或糖尿病。平均而言，基层医疗机构针对抑郁症所采用的护理管理流程不到一种，而且自2006 - 2007年以来，这一应用水平并未改变，无论机构规模大小。相比之下，在规模较大的基层医疗机构中，糖尿病护理管理流程的应用显著增加。这些发现可能表明，尽管美国基层医疗机构提供的抑郁症护理比例很高，但它们在将抑郁症作为一种慢性病进行管理方面的能力并不强。应考虑出台激励抑郁症护理管理的政策，包括增加质量指标。
