Mann A H, Blizard R, Murray J, Smith J A, Botega N, MacDonald E, Wilkinson G
Section of Epidemiology and General Practice, Institute of Psychiatry, London.
Br J Gen Pract. 1998 Jan;48(426):875-9.
The diagnosis and treatment of depression constitutes a significant component of a general practitioner's workload. A pilot study has suggested that the practice nurse may have an important contribution to make in the care of patients with depression.
To evaluate an extended role for practice nurses in improving the outcome of depression through two specially-designed interviews running in parallel.
Two naturalistic, random allocation studies took place concurrently over four months. Study 1 evaluated the effectiveness of standardized psychiatric assessment by a practice nurse and feedback of information to the general practitioner (GP). Study 2 evaluated the above assessment and feedback combined with nurse-assisted follow-up care. Twenty general practices participating in the Medical Research Council General Practice Research Framework took part in the study. Subjects included general practice attenders identified as depressed by their GP. The main outcome measures were a change in Beck Depression Inventory (BDI) scores and in the proportion of patients fulfilling DSM-III criteria for major depression.
A total of 577 patients were recruited; 516 [89% (95% CI = 86-92%)] were rated as depressed on the BDI and 474 [82% (95% CI = 79-85%)] met criteria for DSM-III major depression. Altogether, 524 (91%) patients completed follow-up at four months. All groups of patients showed improvement, but no difference in the rate of improvement was shown for the nurse intervention groups. BDI mean scores fell from 18.54 (95% CI = 17.53-20.06) to 11.53 (95% CI = 10.02-13.04) in Study 1, and from 21.01 (95% = CI 20.26-21.86) to 10.62 (95% CI = 9.73-11.51) in Study 2. The proportion of patients fulfilling criteria for DSM-III major depression in Study 1 fell from 80% (95% CI = 73-87%) to 30% (95% CI = 22-38%), and in Study 2 from 80% (95% CI = 76-84%) to 27% (95% CI = 23-31%). Prescription rates of antidepressant medication were higher than expected, ranging between 63% and 76% in the two studies.
There was an increase in the rate of antidepressant prescription, but no additional benefit could be adduced for patients who received a nurse intervention.
抑郁症的诊断与治疗是全科医生工作量的重要组成部分。一项试点研究表明，执业护士在抑郁症患者护理中可能发挥重要作用。
通过两项并行的专门设计访谈，评估执业护士在改善抑郁症治疗效果方面的扩展作用。
两项自然主义、随机分配研究同时进行，为期四个月。研究1评估执业护士进行标准化精神科评估及向全科医生反馈信息的效果。研究2评估上述评估及反馈并结合护士协助的后续护理。参与医学研究委员会全科医学研究框架的20家全科诊所参与了该研究。研究对象包括被全科医生诊断为抑郁症的全科诊所就诊者。主要结局指标为贝克抑郁量表（BDI）评分的变化以及符合DSM-III重度抑郁症标准的患者比例。
共招募577名患者；516名[89%（95%置信区间=86-92%）]在BDI上被评定为抑郁，474名[82%（95%置信区间=79-85%）]符合DSM-III重度抑郁症标准。总计524名（91%）患者在四个月时完成随访。所有患者组均有改善，但护士干预组在改善率方面未显示出差异。在研究1中，BDI平均评分从18.54（95%置信区间=17.53-20.06）降至11.53（95%置信区间=10.02-13.04），在研究2中从21.01（95%置信区间=20.26-21.86）降至10.62（95%置信区间=9.73-11.51）。在研究1中，符合DSM-III重度抑郁症标准的患者比例从80%（95%置信区间=73-87%）降至30%（95%置信区间=22-38%），在研究2中从80%（95%置信区间=7-84%）降至27%（95%置信区间=23-31%）。抗抑郁药物的处方率高于预期，两项研究中的处方率在63%至76%之间。
抗抑郁药物处方率有所增加，但接受护士干预的患者未显示出额外益处。
