Hannaford P C, Thompson C, Simpson M
Royal College of General Practitioners' Manchester Research Unit.
Br J Gen Pract. 1996 Jun;46(407):333-7.
Take Care is a commercially sponsored educational package for the detection and management of depression by all members of the primary health-care team.
This study was designed to evaluate whether the educational package affects the recognition of psychological illness by general practitioners.
General practitioners working in 13 practices in North West England or Trent Regional Health Authorities took part the evaluation. Patients who scored more than eight on the depression or anxiety component of the Hospital Anxiety and Depression (HAD) scales, and who were thought by their general practitioner to have a totally physical problem or no illness, were deemed to have a psychological illness that had been 'missed' by the doctor. Changes in the proportion of missed cases before and after exposure to Take Care were estimated.
When all practices were considered together, the general practitioners missed a depressive illness in 24.1% of patients before Take Care, and 17.1% afterwards; absolute decrease 7.0% [95% confidence interval (CI) -2.0 to -12.0%]. An improvement was seen in most practices (Wilcoxon matched-pair test P < 0.05). The programme was also associated with a small reduction in the overall proportion of episodes of anxiety missed by the doctor (absolute decrease 4.5%; 95% CI -1.0 to -8.0%) a reduction was found in most practices (Wilcoxon matched-pair test P < 0.05). There was no material difference in the diagnostic false-positive rate of the doctors before and after the introduction of the programme.
Exposure to an educational package for depression was associated with improved recognition of psychological illness by general practitioners.
“关爱计划”是一项由商业机构赞助的教育项目，旨在帮助基层医疗团队的所有成员进行抑郁症的检测和管理。
本研究旨在评估该教育项目是否会影响全科医生对心理疾病的识别。
在英格兰西北部13家诊所或特伦特地区卫生当局工作的全科医生参与了此次评估。在医院焦虑抑郁量表（HAD）的抑郁或焦虑分量表上得分超过8分，且被全科医生认为完全是身体问题或无疾病的患者，被视为患有医生“漏诊”的心理疾病。估计了接触“关爱计划”前后漏诊病例比例的变化。
综合所有诊所来看，全科医生在接触“关爱计划”前漏诊了24.1%的抑郁症患者，之后漏诊率为17.1%；绝对降低了7.0%[95%置信区间（CI）-2.0%至-12.0%]。大多数诊所都有改善（Wilcoxon配对检验P<0.05）。该项目还使医生漏诊焦虑发作的总体比例略有下降（绝对降低4.5%；95%CI -1.0%至-8.0%），大多数诊所都有下降（Wilcoxon配对检验P<0.05）。在引入该项目前后，医生的诊断假阳性率没有实质性差异。
接触抑郁症教育项目与全科医生对心理疾病识别能力的提高有关。
