Patients' depression treatment preferences and initiation, adherence, and outcome: a randomized primary care study.
Patients' depression treatment preferences and initiation, adherence, and outcome: a randomized primary care study.
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DOI：
10.1176/ps.2009.60.3.337
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发表时间：
2009-03
期刊：
影响因子：
--
通讯作者：
Bruce ML
中科院分区：
文献类型：
--
作者：
Raue PJ;Schulberg HC;Heo M;Klimstra S;Bruce ML
我们调查了抑郁症中年和老年初级保健患者的治疗偏好与治疗开始、依从性和临床结果的关系。符合DSM-IV重度抑郁症标准的60名初级保健参与者被随机分为接受与他们的主要陈述偏好一致或不一致的治疗。参与者在护理经理的监督下接受20周的艾司西普兰治疗，或者接受每周12次的人际心理治疗，然后每月进行2次强化治疗。在第4、8、12和24周重新评估对治疗的依从性和抑郁严重程度。参与者表达了比抗抑郁药物更强烈的心理治疗偏好。偏好强度比偏好与指定治疗的一致性与不一致性更敏感地衡量结果。在所有年龄组中，偏好强度与治疗开始和12周依从率显著相关，但与抑郁严重程度或缓解无关。在临床实践中，持续测量偏好强度可能比偏好本身更有用。未来的研究应该集中在患者-临床医生治疗决策过程的更大便利化是否以及如何影响临床结果。
We examined the association of treatment preferences with treatment initiation, adherence, and clinical outcome among depressed mid-life and elderly primary care patients. 60 primary care participants meeting DSM-IV criteria for major depression were randomized to receive treatment congruent or incongruent with their primary stated preference. Participants received either 20 weeks of escitalopram as monitored by a care manager, or 12 weekly sessions of interpersonal psychotherapy followed by 2 monthly booster sessions. Adherence to treatment and depression severity were reassessed at weeks 4, 8, 12, and 24. Participants expressed stronger preferences for psychotherapy than antidepressant medication. Preference strength was a more sensitive measure of outcomes than congruence versus incongruence of preference with the assigned treatment. Across age groups, preference strength was significantly associated with treatment initiation and 12-week adherence rate, but not with depression severity or remission. A continuous measure of preference strength may be a more useful measure in clinical practice than preferences per se. Future research should focus on whether and how greater facilitation of the patient-clinician treatment decision-making process influences clinical outcome.