MDGuidelines at ReedGroup, Ltd., Westminster, Colorado (Gaspar, Zaidel); Department of Psychiatry and Behavioral Sciences, University of California, Davis (Dewa).
Psychiatr Serv. 2019 Apr 1;70(4):262-270. doi: 10.1176/appi.ps.201800275. Epub 2019 Jan 11.
Rates and determinants of pharmacological and psychotherapy use were assessed after a major depressive disorder diagnosis.
In a retrospective claims study that included 2007-2016 records from the IBM MarketScan research databases, use of pharmacotherapy and psychotherapy was tracked in a population of 24,579 patients with a diagnosis of major depressive disorder. Univariate and multiple variable analyses were used to identify determinants of antidepressant adherence (proportion of days covered ≥.8) and intensive psychotherapy at the beginning of treatment (at least four psychotherapy visits in the first 4 weeks after initiating psychotherapy).
In the 12 months following a diagnosis of major depressive disorder, most individuals received pharmacotherapy or psychotherapy (94.7%), and unimodal therapy was more common (58.5%) than bimodal therapy (36.2%). When antidepressants were initiated (N=13,524), 41.7% and 32.0% of patients were adherent in the acute and continuation phases, respectively. Initial antidepressant dosages were outside guideline recommendations for 34.5% of patients prescribed these medications. When psychotherapy was initiated, the median number of visits in the year after a patient's diagnosis was seven. Most patients (54.7%) did not continue to receive either antidepressant or psychotherapy treatment after month 5 following their diagnosis. A shorter time from diagnosis to treatment and a lower percentage of treatment costs paid by the patient were associated with increased antidepressant adherence and intensive psychotherapy use.
Findings indicate that treatment guideline recommendations are not followed for a large proportion of patients with major depressive disorder and that improvement is needed in multiple areas to enhance effective treatment.
评估重度抑郁症诊断后的药物治疗和心理治疗的使用比例及其决定因素。
在一项回顾性索赔研究中，该研究纳入了 IBM MarketScan 研究数据库 2007 年至 2016 年的记录，对 24579 例重度抑郁症诊断患者的药物治疗和心理治疗使用情况进行了跟踪。使用单变量和多变量分析来确定抗抑郁药物治疗的依从性（覆盖天数比例≥0.8）和治疗初期强化心理治疗（在开始心理治疗的前 4 周内至少进行 4 次心理治疗）的决定因素。
在重度抑郁症诊断后的 12 个月中，大多数患者接受了药物治疗或心理治疗（94.7%），单模式治疗（58.5%）比双模式治疗（36.2%）更常见。当开始使用抗抑郁药时（N=13524），分别有 41.7%和 32.0%的患者在急性期和维持期治疗中具有依从性。按照指南建议，34.5%的患者处方的抗抑郁药初始剂量不当。当开始心理治疗时，在患者诊断后的一年中，中位数的就诊次数为 7 次。大多数患者（54.7%）在诊断后 5 个月后不再继续接受抗抑郁药或心理治疗。从诊断到治疗的时间越短，患者自付的治疗费用比例越低，抗抑郁药物治疗的依从性和强化心理治疗的使用率越高。
研究结果表明，很大一部分重度抑郁症患者未遵循治疗指南建议，需要在多个方面进行改进，以提高治疗效果。
