Salvalaggio Ginetta, Meaney Christopher, Moineddin Rahim, Grunfeld Eva, Manca Donna
Ginetta Salvalaggio, University of Alberta, Edmonton, Canada.
BMC Fam Pract. 2017 Jun 17;18(1):73. doi: 10.1186/s12875-017-0645-x.
Primary care plays a pivotal role in the provision of both mental health care and chronic disease prevention and screening (CDPS). Unfortunately, moderate mental illness (MMI) is associated with poorer general health outcomes. Part of this burden of illness may be due to reduced CDPS uptake. The Building on the Existing Tools to Improve Chronic Disease Prevention in Primary Care (BETTER) trial recruited 777 participants ages 40-65 from 32 family practice panels, of whom 135 (18.2%) had elevated GAD scores, 118 (16.4%) had elevated PHQ scores, and 264 (34.0%) had electronic medical record (EMR)-documented MMI. We hypothesized that patients with screen-positive or chart-documented MMI are 1) eligible for more CDPS actions, and 2) able to complete a lower proportion of CDPS actions than patients unaffected by MMI.
This study was a secondary analysis of data from the BETTER trial. Participants were stratified by both EMR-documented MMI and screen-positive evidence of MMI (using the General Anxiety Disorders (GAD-7) and Patient Health Questionnaire (PHQ-9) instruments for anxiety and depression screening, respectively). The primary outcome was the proportion of CDPS actions for which the patient was eligible completed at follow-up, using a composite index.
After adjusting for age, gender, and social support, patients with evidence of MMI had a lower composite index than patients without evidence of MMI (p < 0.05). The lower composite index is primarily due to higher eligibility for CDPS at baseline; ability to complete CDPS was not statistically different.
Patients affected by MMI are eligible for more CDPS actions than their unaffected counterparts. Although they are able to complete a similar number of CDPS actions, they are not able to eliminate their baseline CDPS gap. Primary care teams need to be aware of this increased CDPS eligibility for patients with MMI and ensure best practices in CDPS supports are available to this patient population. Further study is needed to determine the ideal suite of targeted supports.
初级保健在提供精神卫生保健以及慢性病预防与筛查（CDPS）方面发挥着关键作用。不幸的是，中度精神疾病（MMI）与较差的总体健康结果相关。这种疾病负担的一部分可能是由于CDPS的接受率降低。“利用现有工具改善初级保健中的慢性病预防（BETTER）”试验从32个家庭医疗小组招募了777名年龄在40至65岁之间的参与者，其中135人（18.2%）的广泛性焦虑障碍（GAD）评分升高，118人（16.4%）的患者健康问卷（PHQ）评分升高，264人（34.0%）有电子病历（EMR）记录的MMI。我们假设筛查呈阳性或病历记录有MMI的患者：1）有资格接受更多的CDPS措施；2）与未受MMI影响的患者相比，能够完成的CDPS措施比例更低。
本研究是对BETTER试验数据的二次分析。参与者根据EMR记录的MMI和MMI筛查呈阳性的证据（分别使用广泛性焦虑障碍量表（GAD - 7）和患者健康问卷（PHQ - 9）工具进行焦虑和抑郁筛查）进行分层。主要结局是使用综合指数衡量患者在随访时符合条件的CDPS措施的完成比例。
在调整年龄、性别和社会支持因素后，有MMI证据的患者的综合指数低于无MMI证据的患者（p < 0.05）。综合指数较低主要是由于基线时CDPS的资格更高；完成CDPS的能力在统计学上没有差异。
与未受影响的患者相比，受MMI影响的患者有资格接受更多的CDPS措施。尽管他们能够完成的CDPS措施数量相似，但他们无法消除基线时的CDPS差距。初级保健团队需要意识到MMI患者的CDPS资格增加，并确保为这一患者群体提供CDPS支持的最佳实践。需要进一步研究以确定理想的针对性支持组合。
