Maehder Kerstin, Löwe Bernd, Härter Martin, Heddaeus Daniela, Scherer Martin, Weigel Angelika
Department of Psychosomatic Medicine and Psychotherapy, University Medical Center Hamburg-Eppendorf, Germany.
Department of Medical Psychology, University Medical Center Hamburg-Eppendorf, Germany.
Fam Pract. 2019 Jan 25;36(1):38-52. doi: 10.1093/fampra/cmy122.
Stepped care models comprise a graded treatment intensity and a systematic monitoring. For an effective implementation, stepped care models have to account for the high rates of mental and somatic comorbidity in primary care.
The aim of the systematic review was to take stock of whether present stepped care models take comorbidities into consideration. A further aim was to give an overview on treatment components and involved health care professionals.
A systematic literature search was performed using the databases PubMed, PsycINFO, Cochrane Library and Web of Science. Selection criteria were a randomized controlled trial of a primary-care-based stepped care intervention, adult samples, publication between 2000 and 2017 and English or German language.
Of 1009 search results, 39 studies were eligible. One-third of the trials were conceived for depressive disorders only, one-third for depression and further somatic and/or mental comorbidity and one-third for conditions other than depression. In 39% of the studies comorbidities were explicitly integrated in treatment, mainly via transdiagnostic self-management support, interprofessional collaboration and digital approaches for treatment, monitoring and communication. Most care teams were composed of a primary care physician, a care manager and a psychiatrist and/or psychologist. Due to the heterogeneity of the addressed disorders, no meta-analysis was performed.
Several stepped care models in primary care already account for comorbidities, with depression being the predominant target disorder. To determine their efficacy, the identified strategies to account for comorbidities should be investigated within stepped care models for a broader range of disorders.
阶梯式照护模式包括分级治疗强度和系统监测。为有效实施，阶梯式照护模式必须考虑初级保健中精神和躯体共病的高发生率。
本系统评价的目的是评估当前的阶梯式照护模式是否考虑了共病情况。另一个目的是概述治疗组成部分和涉及的医疗保健专业人员。
使用PubMed、PsycINFO、Cochrane图书馆和科学网数据库进行系统文献检索。选择标准为基于初级保健的阶梯式照护干预的随机对照试验、成人样本、2000年至2017年期间发表且语言为英语或德语。
在1009条检索结果中，39项研究符合条件。三分之一的试验仅针对抑郁症，三分之一针对抑郁症以及其他躯体和/或精神共病，三分之一针对抑郁症以外的疾病。在39%的研究中，共病被明确纳入治疗，主要通过跨诊断自我管理支持、跨专业协作以及用于治疗、监测和沟通的数字方法。大多数照护团队由一名初级保健医生、一名照护经理和一名精神科医生和/或心理学家组成。由于所涉及疾病的异质性，未进行荟萃分析。
初级保健中的几种阶梯式照护模式已经考虑了共病情况，抑郁症是主要的目标疾病。为确定其疗效，应在针对更广泛疾病的阶梯式照护模式中研究已确定的应对共病的策略。
