Lauria-Horner Bianca, Beaulieu Tara, Knaak Stephanie, Weinerman Rivian, Campbell Helen, Patten Scott
Department of Psychiatry, Dalhousie University, Halifax, Nova Scotia, Canada.
Opening Minds Anti-Stigma Initiative, Mental Health Commission of Canada, Ottawa, ON, Canada.
BMC Fam Pract. 2018 Nov 28;19(1):183. doi: 10.1186/s12875-018-0862-y.
Depression affects over 400 million people globally. The majority are seen in primary care. Barriers in providing adequate care are not solely related to physicians' knowledge/skills deficits, but also time constraints, lack of confidence/avoidance, which need to be addressed in mental health-care redesign. We hypothesized that family physician (FP) training in the Adult Mental Health Practice Support Program (AMHPSP) would lead to greater improvements in patient depressive symptom ratings (a priori primary outcome) compared to treatment as usual.
From October 2013 to May 2015, in a controlled trial 77 FP practices were stratified on the total number of physicians/practice as well as urban/rural setting, and randomized to the British Columbia AMHPSP⎯a multi-component contact-based training to enhance FPs' comfort/skills in treating mild-moderate depression (intervention), or no training (control) by an investigator not operationally involved in the trial. FPs with a valid license to practice in NS were eligible. FPs from both groups were asked to identify 3-4 consecutive patients > 18 years old, diagnosis of depression, Patient Health Questionnaire (PHQ-9) score ≥ 10, able to read English, intact cognitive functioning.
antidepressants within 5 weeks and psychotherapy within 3 months of enrollment, and clinically judged urgent/emergent medical/psychiatric condition. Patients were assigned to the same arm as their physician. Thirty-six practices recruited patients (intervention n = 23; control n = 13). The study was prematurely terminated at 6 months of enrollment start-date due to concomitant primary health-care transformation by health-system leaders which resulted in increased in-office demands, and recruitment failure. We used the PHQ-9 to assess between-group differences at baseline, 1, 2, 3, and 6 months follow-up. Outcome collectors and assessors were blind to group assignment.
One hundred-and-twenty-nine patients (intervention n = 72; control n = 57) were analysed. A significant improvement in depression scores among intervention group patients emerged between 3 and 6 months, time by treatment interaction, likelihood ratio test (LR) chi2(3) = 7.96, p = .047.
This novel skill-based program shows promise in translating increased FP comfort and skills managing depressed patients into improved patient clinical outcomes⎯even in absence of mental health specialists availability.
#NCT01975948 .
抑郁症在全球影响着超过4亿人。大多数患者在初级保健机构就诊。提供充分治疗的障碍不仅与医生的知识/技能缺陷有关，还与时间限制、缺乏信心/回避有关，这些问题需要在心理健康护理重新设计中加以解决。我们假设，与常规治疗相比，家庭医生（FP）在成人心理健康实践支持项目（AMHPSP）中的培训将使患者抑郁症状评分有更大改善（先验主要结局）。
2013年10月至2015年5月，在一项对照试验中，77个家庭医生诊所根据医生总数/诊所规模以及城市/农村环境进行分层，并随机分为不列颠哥伦比亚省AMHPSP组（一种多成分的基于接触的培训，以提高家庭医生治疗轻中度抑郁症的舒适度/技能，干预组）或无培训组（对照组），由未实际参与试验的研究人员进行分组。在新斯科舍省拥有有效执业执照的家庭医生符合条件。两组的家庭医生都被要求识别3 - 4名连续的18岁以上、诊断为抑郁症、患者健康问卷（PHQ - 9）评分≥10、能阅读英语且认知功能完好的患者。
入组前5周内使用过抗抑郁药，3个月内接受过心理治疗，以及临床判断为紧急/突发的医疗/精神疾病。患者被分配到与他们的医生相同的组。36个诊所招募了患者（干预组n = 23；对照组n = 13）。由于卫生系统领导者同时进行的初级卫生保健转型导致门诊需求增加以及招募失败，该研究在入组开始日期的6个月时提前终止。我们使用PHQ - 9在基线、随访1、2、3和6个月时评估组间差异。结局收集者和评估者对分组情况不知情。
分析了129名患者（干预组n = 72；对照组n = 57）。干预组患者的抑郁评分在3至6个月之间有显著改善，时间与治疗的交互作用，似然比检验（LR）chi2(3)=7.96，p = 0.047。
这个新颖的基于技能的项目显示出一种前景，即即使在没有心理健康专家的情况下，将家庭医生治疗抑郁症患者时提高的舒适度和技能转化为患者更好的临床结局。
#NCT01975948 。
