Callahan C M, Hendrie H C, Dittus R S, Brater D C, Hui S L, Tierney W M
Department of Medicine, Indiana University School of Medicine, Regenstrief Institute for Health Care, Indianapolis 46202-2859.
J Am Geriatr Soc. 1994 Aug;42(8):839-46. doi: 10.1111/j.1532-5415.1994.tb06555.x.
Facilitate primary care physicians' compliance with recommended standards of care for late life depression by reducing barriers to recognition and treatment.
Randomized controlled clinical trial of physician-targeted interventions.
Academic primary care group practice caring for an urban, medically indigent patient population.
PATIENTS/PARTICIPANTS: Patients aged 60 and older who exceeded the threshold on the Centers for Epidemiologic Studies Depression Scale (CES-D) and the Hamilton Depression Rating Scale (HAM-D) and their primary care physicians.
Physicians of intervention patients were provided with patient-specific treatment recommendations during 3 special visits scheduled specifically to address the patient's symptoms of depression. In general, physicians were encouraged to establish a diagnosis of depression and educate their patient about the diagnosis, discontinue medications that can cause or exacerbate depressive symptoms, initiate antidepressants when appropriate, and consider referral to psychiatry. Guidelines for prescribing antidepressants were provided. Control physicians received no intervention, and control patients received usual care.
Frequency of recording a depression diagnosis, stopping medications associated with depression, initiating antidepressant medication, and psychiatry referral; mean changes in HAM-D and Sickness Impact Profile (SIP) scores.
One hundred three physicians and 175 patients were involved in the clinical trial. Physicians of intervention patients were more likely to diagnose depression and prescribe antidepressants (P < 0.01). There were no differences between the groups in the frequency of stopping medications associated with depression or referrals to psychiatry. Medications with the strongest cause and effect relationship to depression were infrequently used in this cohort of patients. Although both groups showed improvement in HAM-D and SIP scores, we were unable to demonstrate significant differences in HAM-D or SIP scores between the 2 groups.
Intensive screening and feedback of patient-specific treatment recommendations increased the recognition and treatment of late life depression by primary care physicians. However, we were unable to demonstrate significant improvement in depression or disability severity among intervention patients despite the informational support provided to their physicians. Efforts to improve the functional status of these patients may require more integrated interventions and more aggressive attempts to target psychosocial stressors traditionally outside the purview of primary care.
通过减少识别和治疗的障碍，促进初级保健医生遵守针对老年抑郁症的推荐治疗标准。
针对医生的干预措施的随机对照临床试验。
为城市贫困医疗人群提供服务的学术初级保健团体诊所。
患者/参与者：年龄在60岁及以上且在流行病学研究中心抑郁量表（CES-D）和汉密尔顿抑郁量表（HAM-D）上超过阈值的患者及其初级保健医生。
在专门安排的3次特殊就诊期间，为干预组患者的医生提供针对患者的治疗建议，以解决患者的抑郁症状。一般而言，鼓励医生诊断抑郁症并向患者说明诊断情况，停用可能导致或加重抑郁症状的药物，在适当的时候开始使用抗抑郁药，并考虑转诊至精神科。提供了抗抑郁药的处方指南。对照医生未接受干预，对照患者接受常规治疗。
记录抑郁症诊断、停用与抑郁症相关药物、开始使用抗抑郁药以及转诊至精神科的频率；HAM-D和疾病影响概况量表（SIP）评分的平均变化。
103名医生和175名患者参与了临床试验。干预组患者的医生更有可能诊断抑郁症并开抗抑郁药（P < 0.01）。两组在停用与抑郁症相关药物或转诊至精神科的频率上没有差异。在该患者队列中，与抑郁症因果关系最强的药物很少使用。尽管两组的HAM-D和SIP评分均有所改善，但我们未能证明两组之间的HAM-D或SIP评分存在显著差异。
对针对患者的治疗建议进行强化筛查和反馈，增加了初级保健医生对老年抑郁症的识别和治疗。然而，尽管为干预组患者的医生提供了信息支持，但我们未能证明干预组患者在抑郁症或残疾严重程度方面有显著改善。改善这些患者功能状态的努力可能需要更综合的干预措施，以及更积极地针对传统上不属于初级保健范畴的心理社会压力源进行干预。
