Strawbridge Rebecca, McCrone Paul, Ulrichsen Andrea, Zahn Roland, Eberhard Jonas, Wasserman Danuta, Brambilla Paolo, Schiena Giandomenico, Hegerl Ulrich, Balazs Judit, Caldas de Almeida Jose, Antunes Ana, Baltzis Spyridon, Carli Vladimir, Quoidbach Vinciane, Boyer Patrice, Young Allan H
Department of Psychological Medicine, Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK.
Centre for Mental Health, University of Greenwich, London, UK.
Eur Psychiatry. 2022 Jun 15;65(1):1-21. doi: 10.1192/j.eurpsy.2022.28.
Despite well-established guidelines for managing major depressive disorder, its extensive disability burden persists. This Value of Treatment mission from the European Brain Council aimed to elucidate the nature and extent of “gaps” between best-practice and current-practice care, specifically to: 1. Identify current treatment gaps along the care pathway and determine the extent of these gaps in comparison with the stepped-care model and 2. Recommend policies intending to better meet patient needs (i.e., minimize treatment gaps).
After agreement upon a set of relevant treatment gaps, data pertaining to each gap were gathered and synthesized from several sources across six European countries. Subsequently, a modified Delphi approach was undertaken to attain consensus among an expert panel on proposed recommendations for minimizing treatment gaps.
Four recommendations were made to increase the depression diagnosis rate (from ~50% episodes), aiming to both increase the number of patients seeking help, and the likelihood of a practitioner to correctly detect depression. These should reduce time to treatment (from ~1 to ~8 years after illness onset) and increase rates of treatment; nine further recommendations aimed to increase rates of treatment (from ~25 to ~50% of patients currently treated), mainly focused on targeting the best treatment to each patient. To improve follow-up after treatment initiation (from ~30 to ~65% followed up within 3 months), seven recommendations focused on increasing continuity of care. For those not responding, 10 recommendations focused on ensuring access to more specialist care (currently at rates of ~5–25% of patients).
The treatment gaps in depression care are substantial and concerning, from the proportion of people not entering care pathways to those stagnating in primary care with impairing and persistent illness. A wide range of recommendations can be made to enhance care throughout the pathway.
尽管针对重度抑郁症的管理已有完善的指南，但其广泛的残疾负担依然存在。欧洲脑理事会开展的这项治疗价值使命旨在阐明最佳实践与当前实践护理之间“差距”的性质和程度，具体目标为：1. 确定护理路径上当前的治疗差距，并与阶梯式护理模式相比较确定这些差距的程度；2. 推荐旨在更好满足患者需求（即尽量减少治疗差距）的政策。
在就一系列相关治疗差距达成共识后，从六个欧洲国家的多个来源收集并综合了与每个差距相关的数据。随后，采用改进的德尔菲法，在专家小组中就减少治疗差距的拟议建议达成共识。
提出了四项提高抑郁症诊断率（从约50%的发作病例）的建议，旨在增加寻求帮助的患者数量以及从业者正确检测抑郁症的可能性。这些建议应缩短治疗时间（从发病后约1年至约8年）并提高治疗率；另外九项建议旨在提高治疗率（从目前接受治疗患者的约25%提高到约50%），主要侧重于为每位患者提供最佳治疗。为改善治疗开始后的随访情况（从3个月内约30%的随访率提高到约65%），七项建议侧重于提高护理的连续性。对于无反应者，十项建议侧重于确保获得更多专科护理（目前患者比例约为5% - 25%）。
抑郁症护理中的治疗差距巨大且令人担忧，从未进入护理路径的人群比例到在初级护理中因病情持续且严重而停滞不前的人群。可以提出广泛的建议以加强整个护理路径的护理。
