Karpenko Olga A, Melikhov Oleg G, Tyazhelnikov Andrej A, Kostyuk Georgiy P
Consort Psychiatr. 2021 Dec 31;2(4):2-12. doi: 10.17816/CP112. eCollection 2021.
Common mental disorders - anxiety and depression - are prevalent among patients with cardiovascular disease (CVD) and diabetes mellitus type 2 (DM) and can negatively influence treatment outcomes and healthcare expenses. Despite the importance of management of depression and anxiety in primary care facilities, the diagnostics and treatment of these disorders remain insufficient in the Russian Federation.
To explore whether the rates of referrals to psychiatrists and indicated pharmacological treatment received due to depression or anxiety among patients with CVD and DM will significantly change in primary healthcare facilities after the training of primary care physicians (PCPhs) to deal with comorbid depression and anxiety (including the algorithm for referral to a psychiatrist).
Patients in primary care outpatient settings with diagnoses of CVD and DM passed screening on anxiety and depression using the Hospital Anxiety and Depression Scale (HADS), and information about the indicated treatment for anxiety or depression was collected when present (Sample 1: =400). The educational programme for PCPhs on the diagnostics of anxiety and depression was then performed, and PCPhs were instructed to refer patients with HADS >7 to a psychiatrist. After the training, the second sample was collected (Sample 2: =178) using the same assessments as for Sample 1. The independent expert (psychiatrist) evaluated whether the patients had received the indicated pharmacological treatment according to the screening criteria used in the study for anxiety and depression for both samples.
The proportions of patients with borderline abnormal and abnormal HADS scores (>7) were 365 (91.2%) and 164 (92.1%) in Sample 1 and Sample 2, respectively. In Sample 1, among patients with HADS >7, 119 (29.8%) received psychopharmacological treatment, but in only 46 (38.7%) cases was it indicated in compliance with the screening criteria. In Sample 2, among patients with HADS >7, 59 (33.1%) received psychopharmacological treatment, and in only 14 (23.7%) cases was it indicated in compliance with the screening criteria. The differences in the indicated pharmacological treatment were not statistically significant, and no one from Sample 2 with HADS >7 met a psychiatrist through PCPh referral.
Anxiety and depression are prevalent in patients with CVD and DM treated in primary care facilities, but these patients may not be receiving the indicated pharmacological treatment. Barriers to referral and the use of psychiatric consultation exist despite the focused training of PCPhs and the straightforward referral protocol provided.
常见精神障碍——焦虑和抑郁——在心血管疾病（CVD）和2型糖尿病（DM）患者中普遍存在，会对治疗结果和医疗费用产生负面影响。尽管在基层医疗设施中管理抑郁和焦虑很重要，但在俄罗斯联邦，这些疾病的诊断和治疗仍然不足。
探讨在对基层医疗医生（PCPhs）进行处理共病抑郁和焦虑（包括转介至精神科医生的算法）培训后，CVD和DM患者因抑郁或焦虑转介至精神科医生的比例以及接受指定药物治疗的情况在基层医疗设施中是否会发生显著变化。
在基层医疗门诊环境中，诊断为CVD和DM的患者使用医院焦虑抑郁量表（HADS）进行焦虑和抑郁筛查，并收集存在焦虑或抑郁时指定治疗的信息（样本1：=400）。然后对PCPhs进行关于焦虑和抑郁诊断的教育计划，并指示PCPhs将HADS>7的患者转介至精神科医生。培训后，使用与样本1相同的评估方法收集第二个样本（样本2：=178）。独立专家（精神科医生）根据研究中用于焦虑和抑郁的筛查标准评估两个样本中的患者是否接受了指定的药物治疗。
样本1和样本2中HADS评分临界异常和异常（>7）的患者比例分别为365（91.2%）和164（92.1%）。在样本1中，HADS>7的患者中，119（29.8%）接受了精神药物治疗，但只有46（38.7%）例符合筛查标准。在样本2中，HADS>7的患者中，59（33.1%）接受了精神药物治疗，只有其中14（23.7%）例符合筛查标准。指定药物治疗的差异无统计学意义，样本2中HADS>7的患者无人通过PCPh转介见到精神科医生。
在基层医疗设施接受治疗的CVD和DM患者中，焦虑和抑郁普遍存在，但这些患者可能未接受指定的药物治疗。尽管对PCPhs进行了重点培训并提供了直接的转介方案，但转介和使用精神科会诊仍存在障碍。
