基层医疗先行（PCP-first）模式筛查和治疗抑郁症：来自 32106 例患者的第二队列 VitalSign 报告。

A primary care first (PCP-first) model to screen and treat depression: A VitalSign report from a second cohort of 32,106 patients.

机构信息

Center for Depression Research and Clinical Care, Department of Psychiatry, UT Southwestern Medical Center, Dallas, TX, United States; Peter O'Donnell Jr. Brain Institute, UT Southwestern Medical Center, Dallas, TX, United States; Department of Population and Data Sciences, UT Southwestern Medical Center, Dallas, TX, United States.

出版信息

Gen Hosp Psychiatry. 2022 Jan-Feb;74:1-8. doi: 10.1016/j.genhosppsych.2021.11.001. Epub 2021 Nov 11.

DOI:10.1016/j.genhosppsych.2021.11.001

PMID:34784574

Abstract

PURPOSE

This report from VitalSign project describes treatment selection, follow-up rates and remission outcomes by initial depression severity using the PCP-FIRST model.

METHODS

This retrospective analysis included 32,106 patients aged ≥12 years screened with the Patient Health Questionnaire 2-item (PHQ-2) from November 2016 to July 2019 across 37 primary care clinics. PHQ-2 positive-screen patients (PHQ-2 ≥ 3) received 9-item PHQ (PHQ-9) and 7-item Generalized Anxiety Disorder scales, clinician assessments, and evaluation for pharmacotherapy management with measurement-based care (MBC).

RESULTS

Of PHQ-2 screened patients, 18.7% (5994/32,106) were positive and received a PHQ-9. Of 5994 patients with PHQ-9, 2571 received a clinical diagnosis of depression of whom, 333 had none-mild depression (PHQ-9 < 10) and 2238 had moderate-severe depression (PHQ-9 ≥ 10). Of the 333 patients with none-mild depression and 2238 patients with moderate-severe depression, 266 and 1929 had at least 18 weeks of data available. Of these, 54.9% (146/266) with none-mild depression and 69.1% (1332/1929) with moderate-severe depression were started on pharmacotherapy. Of the 1478 patients with clinical diagnosis of depression, initiated on pharmacotherapy, 1046 returned for ≥1 follow-up and 616 returned for ≥3 follow-ups over 18 weeks. Of the 1046 patients with ≥1 follow-up visit within 18 weeks, remission rates for patients with mild depression, moderate-severe depression, and overall were 55.6% (66/99), 30% (282/941), and 32.4% (338/1040) respectively.

CONCLUSIONS

Despite this being a real-world, usual care sample, remission outcomes exceed real world remission rate expectations of 6% in primary care.

摘要

目的

本项 VitalSign 项目报告采用 PCP-FIRST 模型，根据初始抑郁严重程度描述了治疗选择、随访率和缓解结局。

方法

本回顾性分析纳入了 2016 年 11 月至 2019 年 7 月期间，37 家初级保健诊所使用患者健康问卷 2 项（PHQ-2）筛选出的 32106 例年龄≥12 岁的患者。PHQ-2 阳性筛查患者（PHQ-2≥3）接受 9 项 PHQ（PHQ-9）和 7 项广泛性焦虑症量表、临床医生评估，以及基于测量的护理（MBC）的药物治疗管理评估。

结果

在 PHQ-2 筛查患者中，18.7%（5994/32106）呈阳性并接受了 PHQ-9 检查。在 5994 例 PHQ-9 患者中，2571 例患者被临床诊断为抑郁症，其中 333 例患者为无轻度抑郁（PHQ-9<10），2238 例患者为中重度抑郁（PHQ-9≥10）。在 333 例无轻度抑郁和 2238 例中重度抑郁患者中，266 例和 1929 例至少有 18 周的可用数据。在这些患者中，无轻度抑郁的患者中有 54.9%（146/266），中重度抑郁的患者中有 69.1%（1332/1929）开始接受药物治疗。在 1478 例临床诊断为抑郁症且开始接受药物治疗的患者中，有 1046 例在 18 周内至少进行了 1 次随访，有 616 例在 18 周内至少进行了 3 次随访。在 1046 例 18 周内至少有 1 次随访的患者中，轻度抑郁、中重度抑郁和总体患者的缓解率分别为 55.6%（66/99）、30%（282/941）和 32.4%（338/1040）。