Center for Depression Research and Clinical Care, UT Southwestern Medical Center, Dallas, Texas (Jha, Granneman, Trombello, Clark, Eidelman, Greer, Trivedi); Departments of Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, New York (Jha); Duke-National University of Singapore, Singapore (Rush); Department of Psychiatry, Duke Medical School, Durham, North Carolina (Rush); Texas Tech University-Health Sciences Center, Permian Basin, Texas (Rush).
Center for Depression Research and Clinical Care, UT Southwestern Medical Center, Dallas, Texas (Jha, Granneman, Trombello, Clark, Eidelman, Greer, Trivedi); Departments of Psychiatry and Neuroscience, Icahn School of Medicine at Mount Sinai, New York, New York (Jha); Duke-National University of Singapore, Singapore (Rush); Department of Psychiatry, Duke Medical School, Durham, North Carolina (Rush); Texas Tech University-Health Sciences Center, Permian Basin, Texas (Rush)
Ann Fam Med. 2019 Jul;17(4):326-335. doi: 10.1370/afm.2418.
This report describes outcomes of an ongoing quality-improvement project (VitalSign6) in a large US metropolitan area to improve recognition, treatment, and outcomes of depressed patients in 16 primary care clinics (6 charity clinics, 6 federally qualified health care centers, 2 private clinics serving low-income populations, and 2 private clinics serving patients with either Medicare or private insurance).
Inclusion in this retrospective analysis was restricted to the first 25,000 patients (aged ≥12 years) screened with the 2-item Patient Health Questionnaire (PHQ-2) in the aforementioned quality-improvement project. Further evaluations with self-reports and clinician assessments were recorded for those with positive screen (PHQ-2 >2). Data collected from August 2014 though November 2016 were available at 3 levels: (1) initial PHQ-2 (n = 25,000), (2) positive screen (n = 4,325), and (3) clinician-diagnosed depressive disorder with 18 or more weeks of enrollment (n = 2,160).
Overall, 17.3% (4,325/25,000) of patients screened positive for depression. Of positive screens, 56.1% (2,426/4,325) had clinician-diagnosed depressive disorder. Of those enrolled for 18 or more weeks, 64.8% were started on measurement-based pharmacotherapy and 8.9% referred externally. Of the 1,400 patients started on pharmacotherapy, 45.5%, 30.2%, 12.6%, and 11.6% had 0, 1, 2, and 3 or more follow-up visits, respectively. Remission rates were 20.3% (86/423), 31.6% (56/177), and 41.7% (68/163) for those with 1, 2, and 3 or more follow-up visits, respectively. Baseline characteristics associated with higher attrition were: non-white, positive drug-abuse screen, lower depression/anxiety symptom severity, and younger age.
Although remission rates are high in those with 3 or more follow-up visits after routine screening and treatment of depression, attrition from care is a significant issue adversely affecting outcomes.
本报告描述了在美国一个大都市区进行的一项正在进行的质量改进项目（VitalSign6）的结果，该项目旨在改善 16 家初级保健诊所（6 家慈善诊所、6 家符合联邦资格的医疗保健中心、2 家为低收入人群服务的私人诊所和 2 家为既有医疗保险又有私人保险的患者服务的私人诊所）中抑郁患者的识别、治疗和结局。
本回顾性分析仅限于上述质量改进项目中使用 2 项患者健康问卷（PHQ-2）筛查的前 25000 名（年龄≥12 岁）患者。对阳性筛查（PHQ-2>2）患者进一步进行自我报告和临床医生评估。从 2014 年 8 月至 2016 年 11 月收集的数据可在 3 个水平上获得：（1）初始 PHQ-2（n=25000），（2）阳性筛查（n=4325），（3）临床诊断为抑郁障碍且登记 18 周或以上的患者（n=2160）。
总体而言，25000 名筛查患者中有 17.3%（4325 名）出现抑郁症状阳性。在阳性筛查中，56.1%（2426/4325）有临床诊断的抑郁障碍。在登记 18 周或以上的患者中，64.8%开始接受基于测量的药物治疗，8.9%转介至外部治疗。在开始药物治疗的 1400 名患者中，分别有 45.5%、30.2%、12.6%和 11.6%的患者在第 0、1、2 和 3 次或更多次随访中进行了治疗。对于有 1、2 和 3 次或更多次随访的患者，缓解率分别为 20.3%（86/423）、31.6%（56/177）和 41.7%（68/163）。
尽管在常规筛查和治疗抑郁后，有 3 次或更多次随访的患者的缓解率较高，但从治疗中流失仍然是一个严重的问题，会对结局产生不利影响。
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