Veterans Affairs Center for the Study of Healthcare Innovation, Implementation and Policy.
Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute.
Psychol Serv. 2023 Nov;20(4):764-769. doi: 10.1037/ser0000795. Epub 2023 Aug 24.
Patients with cancer, especially advanced cancer, experience depression at high rates. We aimed to evaluate the quality of depression care received by patients with solid tumor cancer and advanced solid tumor cancer in Veterans Affairs (VA) primary care clinics. This is a retrospective cohort study of patients seen in 82 VA primary care clinics who newly screened positive for depression on the Patient Health Questionnaire (PHQ-2). Outcomes included timely follow-up within 84 or 180 days (3+ mental health specialty, 3+ psychotherapy, or 3+ primary care visits with depression diagnosis codes) and minimum treatment within 1 year (60+ days antidepressants prescribed, 4+ mental health specialty visits, or 3+ psychotherapy visits). 608,042 individuals were seen in VA primary care clinics during this period; 49,839 patients (8.2%) had solid tumor cancer and 9,278 (1.5%) had advanced or poor-prognosis solid tumor cancer. For 686 observations of patients with cancer and new depression, rates of appropriate follow-up were 22.3% within 84 days and 38.2% within 180 days. For 73 observations of patients with advanced or poor-prognosis cancer and new depression, rates of appropriate follow-up were 21.9% within 84 days and 34.3% within 180 days. Rates of minimum treatment within 1 year were 68.4% and 64.4% for patients with cancer and patients with advanced or poor-prognosis cancer, respectively. Quality of timely depression management is low in patients with solid tumor cancers. Even in health systems with well-integrated mental health services, care gaps remain for patients with cancer and depression. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
癌症患者，尤其是晚期癌症患者，抑郁发生率较高。我们旨在评估退伍军人事务部（VA）初级保健诊所中实体瘤癌症和晚期实体瘤癌症患者所接受的抑郁护理质量。这是一项回顾性队列研究，纳入了在 82 家 VA 初级保健诊所就诊的患者，他们在 PHQ-2 上新筛查出患有抑郁症。结果包括在 84 天或 180 天内及时进行后续治疗（3+心理健康专科、3+心理治疗或 3+初级保健就诊且有抑郁诊断代码）和在 1 年内进行最低限度治疗（60+天开具抗抑郁药、4+心理健康专科就诊或 3+心理治疗就诊）。在此期间，有 608042 人在 VA 初级保健诊所就诊；49839 名患者（8.2%）患有实体瘤癌症，9278 名患者（1.5%）患有晚期或预后不良的实体瘤癌症。对于 686 例患有癌症且新诊断为抑郁症的患者观察，84 天内适当随访的比例为 22.3%，180 天内适当随访的比例为 38.2%。对于 73 例患有晚期或预后不良癌症且新诊断为抑郁症的患者观察，84 天内适当随访的比例为 21.9%，180 天内适当随访的比例为 34.3%。在 1 年内进行最低限度治疗的比例分别为癌症患者的 68.4%和晚期或预后不良癌症患者的 64.4%。实体瘤癌症患者的及时抑郁管理质量较低。即使在心理健康服务整合良好的卫生系统中，癌症和抑郁症患者的护理差距仍然存在。（PsycInfo 数据库记录（c）2023 APA，保留所有权利）。
