医疗助理方案可改善抑郁症筛检率的差异。
Medical Assistant Protocol Improves Disparities in Depression Screening Rates.
机构信息
Pritzker School of Medicine, The University of Chicago, Chicago, Illinois.
Center for Health and The Social Sciences, The University of Chicago, Chicago, Illinois.
出版信息
Am J Prev Med. 2021 Nov;61(5):692-700. doi: 10.1016/j.amepre.2021.05.010. Epub 2021 Jul 18.
INTRODUCTION
Depression is a prevalent condition for which screening rates remain low and disparities in screening exist. This study examines the impacts of a medical assistant screening protocol on the rates of depression screening, overall and by sociodemographic groups, in a primary care setting.
METHODS
Between September 2016 and August 2018, a quasi-experimental study of adult primary care visits was conducted at an urban academic clinic to ascertain the change in the rates of completion of the Patient Health Questionnaire-2 after the implementation of a medical assistant protocol (intervention) versus that of physician-only screening (control arm). Analyses were conducted between April 2019 and April 2020 and used interrupted time-series models with generalized estimating equations.
RESULTS
A total of 45,157 visits by 21,377 unique patients were included. Overall, screening increased from 18% (physician-only screening) to 57% (medical assistant protocol) (p<0.0001). Screening increased for all measured demographics. With physician screening, depression screening was less likely to occur at visits by women (than at visits by men; OR=0.91, 95% CI=0.85, 0.98) and at visits by Black/African American patients (than at visits by White; OR=0.91, 95% CI=0.84, 0.99). However, with the medical assistant protocol, depression screening was more likely to occur at visits by women (than at visits by men; OR=1.07, 95% CI=1.0002, 1.14) and at visits by Black/African American patients (than at visits by White; OR=1.11, 95% CI=1.02, 1.20). In addition, age-related disparities were mitigated for visits by patients aged 40-64 and ≥65 years (e.g., age ≥65 years: physician, OR=0.66, 95% CI=0.59, 0.73; medical assistant protocol, OR=0.78, 95% CI=0.71, 0.85), compared with visits by patients aged 18-39 years.
CONCLUSIONS
Implementation of a medical assistant protocol in a primary care setting may significantly increase depression screening rates while mitigating or removing sociodemographic disparities.
介绍
抑郁症是一种普遍存在的疾病，但其筛查率仍然较低，且存在筛查差异。本研究旨在探讨在初级保健环境中，医疗助理筛查方案对抑郁症筛查率的影响，包括总体筛查率和按社会人口统计学分组的筛查率。
方法
2016 年 9 月至 2018 年 8 月，在一家城市学术诊所进行了一项成人初级保健就诊的准实验研究，以确定实施医疗助理方案（干预组）与仅由医生进行筛查（对照组）后，完成患者健康问卷-2 的比例变化。分析于 2019 年 4 月至 2020 年 4 月进行，使用广义估计方程的中断时间序列模型。
结果
共纳入 45157 次就诊，涉及 21377 名患者。总体而言，筛查率从 18%（仅由医生进行筛查）增加到 57%（医疗助理方案）（p<0.0001）。所有测量的人口统计学特征均显示筛查率增加。在仅由医生进行筛查时，女性就诊时（与男性就诊时相比；OR=0.91，95%CI=0.85，0.98）和黑人/非裔美国人就诊时（与白人就诊时相比；OR=0.91，95%CI=0.84，0.99）接受抑郁症筛查的可能性较低。然而，在医疗助理方案中，女性就诊时（与男性就诊时相比；OR=1.07，95%CI=1.0002，1.14）和黑人/非裔美国人就诊时（与白人就诊时相比；OR=1.11，95%CI=1.02，1.20）接受抑郁症筛查的可能性更高。此外，对于 40-64 岁和≥65 岁的患者就诊（例如，年龄≥65 岁：医生，OR=0.66，95%CI=0.59，0.73；医疗助理方案，OR=0.78，95%CI=0.71，0.85），与 18-39 岁的患者就诊相比，年龄相关性差异得到缓解。
结论
在初级保健环境中实施医疗助理方案可能会显著提高抑郁症筛查率，同时减轻或消除社会人口统计学差异。
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