Comorbidity and healthcare utilization in patients with treatment resistant depression: A large-scale retrospective cohort analysis using electronic health records.
Comorbidity and healthcare utilization in patients with treatment resistant depression: A large-scale retrospective cohort analysis using electronic health records.
复制标题
DOI：
10.1016/j.jad.2022.12.044
复制
发表时间：
2023-03-01
影响因子：
6.6
通讯作者：
Pathak, Jyotishman
中科院分区：
文献类型：
--
作者：
Adekkanattu, Prakash;Olfson, Mark;Susser, Leah C.;Patra, Braja;Vekaria, Veer;Coombes, Brandon J.;Lepow, Lauren;Fennessy, Brian;Charney, Alexander;Ryu, Euijung;Miller, Kurt D.;Pan, Lifang;Yangchen, Tenzin;Talati, Ardesheer;Wickramaratne, Priya;Weissman, Myrna;Mann, John;Biernacka, Joanna M.;Pathak, Jyotishman
关键词：
难治性抑郁症（TRD）患者的医疗合并症和医疗保健利用通常在方便样本中报告，使得估计不可靠。关于TRD患者的合并症和医疗利用的大规模临床研究有限。来自纽约市INSIGHT临床研究网络的超过330万例患者的电子健康记录数据被用于将TRD定义为在12个月内诊断为重度抑郁症（MDD）的患者中开始第三种抗抑郁药治疗方案。比较年龄和性别匹配的TRD和非TRD MDD患者的焦虑障碍、27种合并症和医疗保健利用。在30，218例诊断为MDD的患者中，15.2%的患者符合TRD标准（n = 4605）。与没有TRD的MDD患者相比，TRD患者有更高的焦虑障碍和身体合并症的发生率。缺血性心脏病（OR = 1.38）、中风/短暂性脑缺血发作（OR = 1.57）、慢性肾脏疾病（OR = 1.53）、关节炎（OR = 1.52）、髋/骨盆骨折（OR = 2.14）和癌症（OR = 1.41）的几率也较高。与非TRD MDD相比，TRD患者的急诊室就诊率和住院率更高。与无MDD的患者相比，TRD和非TRD MDD患者的焦虑障碍和躯体合并症水平显著较高。INSIGHT-CRN数据缺乏有关抑郁症严重程度和药物依从性的信息。与非TRD MDD患者相比，TRD患者的各种精神和医学合并症的患病率显著更高，医疗保健利用率也更高。这些发现突出了制定干预措施和护理协调策略以满足TRD患者复杂临床需求的挑战。
Medical comorbidity and healthcare utilization in patients with treatment resistant depression (TRD) is usually reported in convenience samples, making estimates unreliable. There is only limited large-scale clinical research on comorbidities and healthcare utilization in TRD patients. Electronic Health Record data from over 3.3 million patients from the INSIGHT Clinical Research Network in New York City was used to define TRD as initiation of a third antidepressant regimen in a 12-month period among patients diagnosed with major depressive disorder (MDD). Age and sex matched TRD and non-TRD MDD patients were compared for anxiety disorder, 27 comorbid medical conditions, and healthcare utilization. Out of 30,218 individuals diagnosed with MDD, 15.2 % of patients met the criteria for TRD (n = 4605). Compared to MDD patients without TRD, the TRD patients had higher rates of anxiety disorder and physical comorbidities. They also had higher odds of ischemic heart disease (OR = 1.38), stroke/transient ischemic attack (OR = 1.57), chronic kidney diseases (OR = 1.53), arthritis (OR = 1.52), hip/pelvic fractures (OR = 2.14), and cancers (OR = 1.41). As compared to non-TRD MDD, TRD patients had higher rates of emergency room visits, and inpatient stays. In relation to patients without MDD, both TRD and non-TRD MDD patients had significantly higher levels of anxiety disorder and physical comorbidities. The INSIGHT-CRN data lack information on depression severity and medication adherence. TRD patients compared to non-TRD MDD patients have a substantially higher prevalence of various psychiatric and medical comorbidities and higher health care utilization. These findings highlight the challenges of developing interventions and care coordination strategies to meet the complex clinical needs of TRD patients.
登录
查看更多内容
DOI：
10.1136/amiajnl-2014-002764
发表时间：
2014-07
期刊：
Journal of the American Medical Informatics Association : JAMIA
影响因子：
--
作者：
Kaushal R;Hripcsak G;Ascheim DD;Bloom T;Campion TR Jr;Caplan AL;Currie BP;Check T;Deland EL;Gourevitch MN;Hart R;Horowitz CR;Kastenbaum I;Levin AA;Low AF;Meissner P;Mirhaji P;Pincus HA;Scaglione C;Shelley D;Tobin JN;NYC-CDRN
通讯作者：
NYC-CDRN
影响因子：
--
作者：
Glassman, Alexander H.;Bigger, J. Thomas, Jr.;Gaffney, Michael
通讯作者：
Gaffney, Michael
DOI：
10.1080/13651501.2021.2003405
发表时间：
2021-11-29
影响因子：
3
作者：
Brenner, Philip;Nygren, Adam;Reutfors, Johan
通讯作者：
Reutfors, Johan
影响因子：
5.6
作者：
Amital, D.;Fostick, L.;Zohar, J.
通讯作者：
Zohar, J.
影响因子：
6.6
作者：
Amital, D.;Fostick, L.;Spivak, B.
通讯作者：
Spivak, B.