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丹麦全科医疗中抑郁症或焦虑症患者的协作护理与会诊联络:Collabri Flex试验的18个月随访

Collaborative Care Versus Consultation Liaison for Patients With Depression or Anxiety Disorders in General Practice in Denmark: 18-Month Follow-Up From the Collabri Flex Trials.

作者信息

Curth Nadja Kehler, Bjørkedal Siv Therese Bogevik, Hjorthøj Carsten, Brinck-Claussen Ursula, Jørgensen Kirstine Bro, Rosendal Susanne, Bojesen Anders Bo, Nordentoft Merete, Eplov Lene Falgaard

机构信息

Copenhagen Research Center for Mental Health, Mental Health Center Copenhagen, Copenhagen University Hospital, Mental Health Services-Capital Region of Denmark, Hellerup, Denmark.

Department of Public Health, Section of Epidemiology, University of Copenhagen, Copenhagen, Denmark.

出版信息

Depress Anxiety. 2025 Jun 5;2025:2909617. doi: 10.1155/da/2909617. eCollection 2025.

Abstract

To our knowledge, no research has reported long-term follow-up results from studies comparing collaborative care to consultation liaison in general practice. We have earlier reported 6-month follow-up. In this article, we report the 18-month follow-up results from the two Danish Collabri Flex studies. We compared collaborative care to consultation liaison in two randomized controlled trials for persons with anxiety disorders and depression, respectively. Both interventions sought to improve the quality of depression and anxiety care, but they differed in the extent mental health specialists were involved. As part of the consultation liaison intervention, psychiatrists and care managers could provide advice and suggestions to the general practitioner (GP). In the collaborative care intervention, psychiatrists and care managers could provide advice and suggestions, and care managers could help the GP manage patient care. 18 months after randomization, we collected follow-up data. Outcomes included anxiety symptoms (BAI), depression symptoms (BDI-II), well-being (WHO-5), functional disability (Sheehan Disability Scale), general psychological symptoms (SCL-90-R), and others. In the depression trial, we found a statistically significant difference in depression symptoms between intervention groups at 18-month follow-up, in favor of collaborative care (4.4, 95%CI 2.8-7.0, ≤ 0.001). Many other outcomes showed significant differences between groups, such as anxiety symptoms, functional level, well-being, general psychological symptoms, and self-efficacy. In the anxiety trial, we found no statistically significant difference between groups in anxiety symptoms (1.2, 95%CI -0.3-2.7, ≤ 0.126). In this trial, significant differences between groups were found in outcomes measuring depression symptoms and general psychological symptoms but not in outcomes measuring functional level, well-being or self-efficacy. In both trials, no differences were found between groups on employment/education or sick leave measures. However, the collaborative care group in both trials had fewer contacts with private practicing psychologists during the 18 months follow-up. At 18-month follow-up, we found a statistically significant difference between allocation groups, when measuring depression symptoms in the depression trial but not when measuring anxiety symptoms in the anxiety trial. Further, the collaborative care intervention may have the potential to reduce referrals to private practicing psychologists, a service that is in high demand in Denmark. ClinicalTrials.gov identifier: NCT03113175 and NCT03113201.

摘要

据我们所知,尚无研究报告在全科医疗中将协作式照护与会诊联络进行比较的长期随访结果。我们之前报告过6个月的随访情况。在本文中,我们报告丹麦两项Collabri Flex研究的18个月随访结果。我们分别在两项针对焦虑症患者和抑郁症患者的随机对照试验中,将协作式照护与会诊联络进行了比较。两种干预措施都旨在提高抑郁和焦虑护理的质量,但它们在精神科专家参与的程度上有所不同。作为会诊联络干预措施的一部分,精神科医生和护理经理可以向全科医生(GP)提供建议。在协作式照护干预中,精神科医生和护理经理可以提供建议,护理经理还可以帮助全科医生管理患者护理。随机分组18个月后,我们收集了随访数据。结果指标包括焦虑症状(BAI)、抑郁症状(BDI-II)、幸福感(WHO-5)、功能残疾(希恩残疾量表)、一般心理症状(SCL-90-R)等。在抑郁症试验中,我们发现干预组在18个月随访时抑郁症状存在统计学显著差异,协作式照护更具优势(4.4,95%CI 2.8 - 7.0,≤0.001)。许多其他结果指标在组间也显示出显著差异,如焦虑症状、功能水平、幸福感、一般心理症状和自我效能感。在焦虑症试验中,我们发现组间焦虑症状无统计学显著差异(1.2,95%CI -0.3 - 2.7,≤0.126)。在该试验中,组间在测量抑郁症状和一般心理症状的结果指标上存在显著差异,但在测量功能水平、幸福感或自我效能感的结果指标上没有差异。在两项试验中,组间在就业/教育或病假措施方面均未发现差异。然而,在18个月的随访期间,两项试验中的协作式照护组与私人执业心理学家的接触较少。在18个月随访时,我们发现抑郁症试验中测量抑郁症状时,分配组之间存在统计学显著差异,但焦虑症试验中测量焦虑症状时不存在差异。此外,协作式照护干预可能有潜力减少转介至私人执业心理学家的情况,而这一服务在丹麦需求很大。ClinicalTrials.gov标识符:NCT03113175和NCT03113201。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/27e9/12162161/0c422b92df53/DA2025-2909617.001.jpg

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