Freytag Antje, Krause Markus, Lehmann Thomas, Schulz Sven, Wolf Florian, Biermann Janine, Wasem Jürgen, Gensichen Jochen
Institute of General Practice and Family Medicine, Jena University Hospital, Germany.
Institute of Medical Statistics, Computer Sciences and Documentation, Jena University Hospital, Germany.
Gen Hosp Psychiatry. 2017 Mar-Apr;45:91-98. doi: 10.1016/j.genhosppsych.2016.12.008. Epub 2016 Dec 23.
For most patients with depression, GPs are the first and long-term medical providers. GP-centered health care (GPc-HC) programs target patients with chronic diseases. What are the effects of GPc-HC on primary care depression management?
An observational retrospective case-control study was conducted using health insurance claims data of patients with depressive disorder from July 2011 to December 2012.
From 40,298 patients insured with the largest health plan in Central Germany participating in the GPc-HC program (intervention group, IG), we observed 4645 patients with depression over 18months: 72.2% women; 66.6years (mean); multiple conditions (morbidity-weight 2.50 (mean), 86%>1.0). We compared them with 4013 patients who did not participate (control group). In participants we found lower number of incomplete/non-specified depression diagnoses (4.46vs.4.82;MD-0.36; p<0.01); lower rate of patients consulting more than one GP-practice (49.1%vs.58.0%;PP-8.9;p<0.01); more GP-contacts (18.19vs.15.59;MD+2.60;p<0.01); more GP-initiated referrals to specialists (82.9%vs.79.3%;PP+3.6;p<0.05), more antidepressant pharmacotherapy prescribed by a GP (37.9%vs.35.4%;PP+2.5;p<0.05), more frequent guideline-concordant therapy duration (19.2%vs.13.1%;PP+6.1;p<0.01) and more patients receiving "GP-psychosomatic basic care" (38.2%vs.30.2%;PP+8.0;p<0.01).
Depressive patients participating in a GPc-HC program may be more often diagnosed by a GP, receive symptom-monitoring and appropriate depression treatment.
对于大多数抑郁症患者而言，全科医生是其首位且长期的医疗服务提供者。以全科医生为中心的医疗保健（GPc-HC）项目针对的是慢性病患者。GPc-HC对初级保健中抑郁症管理的效果如何？
利用2011年7月至2012年12月期间抑郁症患者的医疗保险理赔数据进行了一项观察性回顾性病例对照研究。
在德国中部参加GPc-HC项目（干预组，IG）的最大健康保险计划所覆盖的40298名患者中，我们在18个月内观察到4645例抑郁症患者：女性占72.2%；平均年龄66.6岁；患有多种疾病（发病权重2.50（平均），86%>1.0）。我们将他们与4013名未参与者（对照组）进行了比较。在参与者中，我们发现不完全/未明确的抑郁症诊断数量较少（4.46对4.82；MD -0.36；p<0.01）；咨询不止一位全科医生诊所的患者比例较低（49.1%对58.0%；PP -8.9；p<0.01）；与全科医生的接触更多（18.19对15.59；MD +2.60；p<0.01）；全科医生发起的转介给专科医生的比例更高（82.9%对79.3%；PP +3.6；p<0.05），全科医生开具的抗抑郁药物治疗更多（37.9%对35.4%；PP +2.5；p<0.05），符合指南的治疗持续时间更频繁（19.2%对13.1%；PP +6.1；p<0.01），接受“全科医生身心基础护理”的患者更多（38.2%对30.2%；PP +8.0；p<0.01）。
参加GPc-HC项目的抑郁症患者可能更常被全科医生诊断，接受症状监测和适当的抑郁症治疗。
