Samples Hillary, Stuart Elizabeth A, Saloner Brendan, Barry Colleen L, Mojtabai Ramin
Columbia University Mailman School of Public Health, New York, NY, USA.
Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
J Gen Intern Med. 2020 Jan;35(1):12-20. doi: 10.1007/s11606-019-05192-3. Epub 2019 Aug 6.
Primary care providers encounter a large proportion of the population with depression. Yet, many primary care patients with depression remain undiagnosed and untreated.
This study aims to examine depression screening patterns and the role of screening in depression diagnosis and treatment in the outpatient primary care setting.
This is a cross-sectional analysis of nationally representative survey data of visits to outpatient physician offices from the 2005 to 2015 National Ambulatory Medical Care Surveys.
The sample included the first visit in the past year to a primary care provider by patients 12 years and older (N = 16,887).
The associations of visit characteristics with depression screening and of depression screening with depression diagnosis and treatment during the visit were assessed using logistic regression. Logistic regression with propensity score weighting was used to estimate the odds of depression diagnosis and treatment under the counterfactual scenario in which patients who visited providers with lower depression screening rates had visited providers with higher screening rates instead. All models were adjusted for patient and visit characteristics.
A small proportion of sample visits involved depression screening (3.0%). Visits by patients with depressive symptom complaints were associated with higher odds of depression screening than other visits. When visits were weighted to have similar demographic and clinical characteristics, visits to providers with higher screening rates had higher odds of diagnosis (OR = 1.99, p < 0.001) and treatment (OR = 1.61, p = 0.001) compared to visits to providers with lower screening rates.
Physicians appear to use depression screening selectively based on patients' presenting symptoms. Higher screening rates were associated with higher odds of depression diagnosis and treatment, and even modest increases in screening rates could meaningfully increase population-level rates of depression identification and treatment in primary care. Future research is needed to identify barriers to depression care and implement systematic interventions to improve services and patient outcomes.
基层医疗服务提供者接诊了很大比例的抑郁症患者。然而，许多患有抑郁症的基层医疗患者仍未得到诊断和治疗。
本研究旨在探讨门诊基层医疗环境中抑郁症筛查模式以及筛查在抑郁症诊断和治疗中的作用。
这是一项对2005年至2015年国家门诊医疗调查中门诊医生办公室就诊情况的全国代表性调查数据进行的横断面分析。
样本包括12岁及以上患者在过去一年首次就诊于基层医疗服务提供者的情况（N = 16,887）。
使用逻辑回归评估就诊特征与抑郁症筛查之间的关联，以及就诊期间抑郁症筛查与抑郁症诊断和治疗之间的关联。使用倾向得分加权的逻辑回归来估计在反事实情景下抑郁症诊断和治疗的几率，即就诊于抑郁症筛查率较低的提供者的患者改为就诊于筛查率较高的提供者的情况。所有模型均针对患者和就诊特征进行了调整。
一小部分样本就诊涉及抑郁症筛查（3.0%）。有抑郁症状主诉的患者就诊时进行抑郁症筛查的几率高于其他就诊。当对就诊进行加权以使其具有相似的人口统计学和临床特征时，与就诊于筛查率较低的提供者相比，就诊于筛查率较高的提供者的患者诊断（OR = 1.99，p < 0.001）和治疗（OR = 1.61，p = 0.001）的几率更高。
医生似乎根据患者的症状表现有选择地进行抑郁症筛查。较高的筛查率与抑郁症诊断和治疗的较高几率相关，即使筛查率适度提高也可能显著提高基层医疗中抑郁症识别和治疗的人群水平。未来需要开展研究以确定抑郁症护理的障碍，并实施系统性干预措施以改善服务和患者结局。
