Treatment Differences in Primary and Specialty Settings in Veterans with Major Depression.
Treatment Differences in Primary and Specialty Settings in Veterans with Major Depression.
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DOI：
10.3122/jabfm.2021.02.200475
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发表时间：
2021-03
期刊：
影响因子：
--
通讯作者：
Kessler RC
中科院分区：
文献类型：
--
作者：
Puac-Polanco V;Leung LB;Bossarte RM;Bryant C;Keusch JN;Liu H;Ziobrowski HN;Pigeon WR;Oslin DW;Post EP;Kessler RC
退伍军人健康管理局（VHA）支持全国最大的初级保健-心理健康整合协作护理模式（PC-MHI），以增加初级保健中轻度至中度常见精神障碍的治疗，并将更严重的复杂病例转介到专业机构。然而，目前尚不清楚这种治疗分配在实践中如何发挥作用。在2018年12月至2020年6月期间寻求抑郁症事件发作VHA治疗的2，610名患者完成了关于抑郁症严重程度-复杂性的基线自我报告问卷。排除有主动自杀倾向或严重精神障碍史的患者。管理数据用于确定接下来30天的治疗设置和类型。百分之三十四（34.2%）的抑郁症患者在初级保健（PC）环境中接受治疗，65.8%在专业环境（SMH）中接受治疗。与SMH患者相比，PC患者的抑郁程度较轻，共病抑郁发作较少。严重程度和/或复杂程度最低的患者最有可能接受PC抗抑郁药物治疗，而严重程度和/或复杂程度最高的患者最有可能接受联合治疗（即，药物和心理治疗）治疗。虽然这种患者在不同环境和治疗类型中的分配比以前的民用研究中发现的更强，但不如预期的那么明显（交叉验证的AUC= 0.50 - 0.68）。通过扩大循证治疗，VHA的PC-MHI增加了治疗分配与抑郁症患者临床特征的一致性。需要继续研究，进一步了解该分配不如预期明显的原因以及对治疗反应的影响。
The Veterans Health Administration (VHA) supports the nation’s largest Primary Care-Mental Health Integration collaborative care model–(PC-MHI)–to increase treatment of mild to moderate common mental disorders in primary care and refer more severe-complex cases to specialty settings. It is unclear, though, how this treatment assignment works in practice. 2,610 patients who sought incident episode VHA treatment for depression between December 2018 and June 2020 completed a baseline self-report questionnaire about depression severity-complexity. Patients with active suicidality or history of severe mental disorders were excluded. Administrative data were used to determine settings and types of treatment over the next 30 days. Thirty-four percent (34.2%) of depressed patients received treatment in a primary care (PC) setting and 65.8% in a specialty setting (SMH). PC patients had less severe and fewer comorbid depressive episodes than those in SMH. Patients with the lowest severity and/or complexity were most likely to receive PC antidepressant medication treatment, whereas those with the highest severity and/or complexity were most likely to receive combined (i.e., medication and psychotherapy) treatment in SMH settings. Although this assignment of patients across settings and types of treatment was stronger than found in previous civilian studies, it was less pronounced than expected (cross-validated AUC=.50-.68). By expanding access to evidence-based treatments, VHA’s PC-MHI increases consistency of treatment assignment with clinical characteristics of depressed patients. Increased understanding of reasons for this assignment being less pronounced than expected and implications for treatment response will require continued study.
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影响因子：
--
作者：
Gelhorn, Heather L;Sexton, Chris C;Classi, Peter M
通讯作者：
Classi, Peter M
影响因子：
7
作者：
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通讯作者：
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影响因子：
7
作者：
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通讯作者：
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影响因子：
4.2
作者：
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通讯作者：
Crane, Paul K.
影响因子：
4.5
作者：
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通讯作者：
FRIEDMAN, JH