The effect of targeted and tailored patient depression engagement interventions on patient-physician discussion of suicidal thoughts: a randomized control trial.
The effect of targeted and tailored patient depression engagement interventions on patient-physician discussion of suicidal thoughts: a randomized control trial.
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有针对性和量身定制的患者抑郁参与干预措施对患者与医生自杀想法讨论的影响：一项随机对照试验。
DOI：
10.1007/s11606-014-2843-8
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发表时间：
2014
影响因子：
5.7
通讯作者：
Kravitz,RichardL
中科院分区：
文献类型：
--
作者：
Shah,Ruby;Franks,Peter;Jerant,Anthony;Feldman,Mitchell;Duberstein,Paul;FernandezyGarcia,Erik;Hinton,Ladson;Strohecker,Lorrie;Kravitz,RichardL
背景尽管抑郁症的诊断和治疗有所改善，但初级保健提供者(PCP)对抑郁症状患者中自杀想法的讨论仍然很少。目的确定与注意对照组相比，有针对性的抑郁症公共服务公告(PSA)视频或单独定制的交互式多媒体计算机程序(IMCP)是否会导致初级保健提供者(PCP)对临床抑郁症风险较高的患者自杀想法的讨论增加。设计在加利福尼亚州北部五个不同医疗系统进行的随机对照试验；两个学术界、两个退伍军人事务部(VA)和一个团体模式健康维护组织(HMO)。PARTICIPANSET67名参与者，平均年龄51.7岁；43.9%的妇女，43.4%来自种族/少数民族群体。干预PSA针对性别和社会经济地位，旨在鼓励患者寻求抑郁症治疗或询问有关抑郁症的信息。IMCP是一种个性化的互动健康信息，旨在激发患者讨论可能的抑郁症状。注意力控制是一段睡眠卫生视频。一位临床医生报告了关于自杀念头的讨论。分析按抑郁症状级别进行分层(患者健康问卷评分 <； 9[轻度或更低]与≥10[至少中度])。KEY结果在PHQ-9评分≥为10的患者中，IMCP组讨论自杀念头的概率显著高于对照组(调整后优势比 = 2.33，95%可信区间 = 1.5，5.10，p= 0.03)。在PHQ-9评分为 <； 9的患者中，任何一种干预措施都没有显著影响PCP对自杀念头的讨论。结论至少有中度抑郁症状的患者接受个性化的干预，旨在增加患者对抑郁症护理的参与度，导致PCP对自杀念头的讨论增加。
BACKGROUNDDespite improvements in the diagnosis and treatment of depression, primary care provider (PCP) discussion regarding suicidal thoughts among patients with depressive symptoms remains low.OBJECTIVETo determine whether a targeted depression public service announcement (PSA) video or an individually tailored interactive multimedia computer program (IMCP) leads to increased primary care provider (PCP) discussion of suicidal thoughts in patients with elevated risk for clinical depression when compared to an attention control.DESIGNRandomized control trial at five different healthcare systems in Northern California; two academic, two Veterans Affairs (VA), and one group-model health maintenance organization (HMO).PARTICIPANTSEight-hundred sixty-seven participants, with mean age 51.7; 43.9 % women, 43.4 % from a racial/ethnic minority group.INTERVENTIONThe PSA was targeted to gender and socio-economic status, and designed to encourage patients to seek depression care or request information regarding depression. The IMCP was an individually tailored interactive health message designed to activate patients to discuss possible depressive symptoms. The attention control was a sleep hygiene video.MAIN MEASURESClinician reported discussion of suicidal thoughts. Analyses were stratified by depressive symptom level (Patient Health Questionnaire [PHQ-9] score < 9 [mild or lower] versus ≥ 10 [at least moderate]).KEY RESULTSAmong patients with a PHQ-9 score ≥ 10, PCP discussion of suicidal thoughts was significantly higher in the IMCP group than in the control group (adjusted odds ratio = 2.33, 95 % confidence interval = 1.5, 5.10,p= 0.03). There were no significant effects of either intervention on PCP discussion of suicidal thoughts among patients with a PHQ-9 score < 9.CONCLUSIONSExposure of patients with at least moderate depressive symptoms to an individually tailored intervention designed to increase patient engagement in depression care led to increased PCP discussion of suicidal thoughts.