Metrikin Benjamin, Hill Rebecca L, Liu Jialuo, Adams John, Duggan Mark C, Perlman Sabrina, Coleman Karen J
Kaiser Permanente Bernard J Tyson School of Medicine, Pasadena, CA, USA.
Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA.
Perm J. 2025 Mar 14;29(1):27-42. doi: 10.7812/TPP/24.117. Epub 2024 Dec 5.
The COVID-19 pandemic forced a rapid shift toward virtual modalities for the treatment of depression in primary care.
Participants were adults 18 years and older with a new episode of depression diagnosed in primary care between March 1, 2020, and May 21, 2021, and moderate-to-severe symptoms of depression at the time of diagnosis (N = 9619). Outcomes were 1) antidepressant medications prescribed and dispensed (referred to as received), as well as adherence to those medications; 2) referrals made to depression-related services and the receipt of those services; and 3) a follow-up visit completed with the diagnosing practitioner regardless of treatment actions.
Patients were 42.4 ± 17.8 years old, and 77.6% had moderate-to-severe symptoms at diagnosis. Most patients were women (70.4%), 48.2% were Hispanic, and 8.4% were Black. Telephone visits were associated with 64% increased odds of having an antidepressant prescribed when compared to in-person visits. However, patients prescribed an antidepressant during a telephone visit were 52% less likely to receive this prescription when compared to patients who were prescribed an antidepressant during an in-person visit. Telephone and video visits were associated with 48% and 37% decreased odds, respectively, of having a follow-up visit with the prescribing practitioner when compared to an in-person visit.
Telemedicine for depression in adult primary care may result in greater antidepressant prescribing than in-person care, but these medications are less likely to be received. This study's findings suggest that health systems should adjust electronic decision support tools (such as mail-order pharmacies) to ensure virtual care decisions are implemented.
新冠疫情迫使初级保健中抑郁症的治疗迅速转向虚拟模式。
参与者为2020年3月1日至2021年5月21日期间在初级保健中被诊断为新发抑郁症发作且诊断时具有中度至重度抑郁症状的18岁及以上成年人（N = 9619）。结果包括：1）开具并配发（称为接受）的抗抑郁药物以及对这些药物的依从性；2）转介至抑郁症相关服务机构以及接受这些服务；3）无论采取何种治疗措施，均与诊断医生完成一次随访就诊。
患者年龄为42.4 ± 17.8岁，77.6%在诊断时有中度至重度症状。大多数患者为女性（70.4%），48.2%为西班牙裔，8.4%为黑人。与面对面就诊相比，电话就诊开具抗抑郁药物的几率增加64%。然而，与在面对面就诊时开具抗抑郁药物的患者相比，在电话就诊时开具抗抑郁药物的患者接受该处方的可能性降低52%。与面对面就诊相比，电话和视频就诊与与开处方医生进行随访就诊的几率分别降低48%和37%。
成人初级保健中抑郁症的远程医疗可能比面对面护理导致更多的抗抑郁药物处方，但这些药物被接受的可能性较小。本研究结果表明，卫生系统应调整电子决策支持工具（如邮购药房），以确保虚拟护理决策得以实施。
