Heidari Elham, Eslami Saeid, Abolhassani Farid, Sharifi Vandad, Taherzadeh Zhila, Daneshvar Tahoura
Non-communicable Diseases Research Center, Endocrinology and Metabolism Population Science Institute, Tehran University of Medical Sciences, Tehran, Iran.
Pharmaceutical Research Center, Mashhad University of Medical Sciences, Mashhad, Iran, Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Arch Iran Med. 2017 May;20(5):308-313.
The aim of the paper is to investigate the association between physicians' adherence to a pharmacotherapy guideline and continuity of care for patients with depressive and/or anxiety disorders in a collaborative care program.
This retrospective observational study was conducted using medical records of subjects suffering from depression and/or anxiety disorder visited by 26 general practitioners (GP) working with Community Mental Health Center (CMHC), who run a collaborative care program in Tehran, Iran. All patients were visited by a general practitioner in private offices from November 2010 to May 2013. A scoring system was utilized to assess physicians' adherence to the pharmacotherapy guideline using medical records. Patients' continuity of care was calculated based on the number of days of being in the collaborative care program. To investigate the association between physicians' adherence to the guideline and the patients' continuity of care, univariate logistic regression analysis, multiple logistic regression analysis and parametric survival analysis were performed using Stata version 11.
A total of 3,338 patients were studied. Their mean age was 37 years and 81.6% were female. Being treated by a particular GP was an important factor in patients with depressive and/or anxiety diagnosis as well as having both diagnoses. Furthermore, higher score of adherence to the guideline was associated with less continuity of care in depressive patients.
Being treated by certain GPs is an effective way of retention of patients in the treatment. The results demonstrate that patients with guideline-based pharmacotherapy need to be told about continuity of care in community mental health program.
本文旨在研究在一项协作护理项目中，医生对药物治疗指南的遵循情况与抑郁和/或焦虑症患者护理连续性之间的关联。
本回顾性观察研究使用了26名在伊朗德黑兰运营协作护理项目的社区心理健康中心（CMHC）工作的全科医生（GP）所诊治的患有抑郁和/或焦虑症患者的病历。所有患者在2010年11月至2013年5月期间在全科医生的私人诊所就诊。利用一个评分系统，通过病历评估医生对药物治疗指南的遵循情况。根据患者参与协作护理项目的天数计算护理连续性。为了研究医生对指南的遵循情况与患者护理连续性之间的关联，使用Stata 11版本进行单因素逻辑回归分析、多因素逻辑回归分析和参数生存分析。
共研究了3338名患者。他们的平均年龄为37岁，81.6%为女性。由特定的全科医生进行治疗，对于患有抑郁和/或焦虑症诊断以及同时患有这两种诊断的患者来说是一个重要因素。此外，在抑郁症患者中，较高的指南遵循得分与较低的护理连续性相关。
由特定的全科医生进行治疗是使患者持续接受治疗的有效方式。结果表明，在社区心理健康项目中，需要告知接受基于指南的药物治疗的患者有关护理连续性的信息。
