ADEQUACY AND DURATION OF ANTIDEPRESSANT TREATMENT IN PRIMARY CARE
ADEQUACY AND DURATION OF ANTIDEPRESSANT TREATMENT IN PRIMARY CARE
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DOI：
10.1097/00005650-199201000-00007
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发表时间：
1992-01-01
期刊：
影响因子：
3
通讯作者：
ORMEL, J
中科院分区：
文献类型：
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作者：
KATON, W;VONKORFF, M;ORMEL, J
在119名初级保健的苦恼高利用者的样本中，45%被精神科医生评估为需要抗抑郁治疗的患者在检查前一年接受了治疗。然而，只有11%的需要抗抑郁药的患者接受了足够的剂量和持续时间的药物治疗。在干预后的一年中，研究患者的医生在精神科咨询期间被建议进行治疗，相对于随机对照组（36.1%），他们更有可能接受抗抑郁药物治疗（52.7%）。然而，干预并没有显着增加提供足够的抗抑郁治疗（37.1%对27.9%）。在使用抗抑郁药的研究患者中，患者特征无法区分接受足够剂量和持续时间的抗抑郁药的患者与未接受抗抑郁药的患者。对所有开始使用抗抑郁药的健康维护组织登记者的抗抑郁药治疗持续时间数据进行分析，结果显示，只有20%的患者接受了第一代抗抑郁药的处方，在接下来的六个月里，服用了四种或四种以上抗抑郁药（阿米替林、丙咪嗪或多虑平）的患者中，（去甲替林、地昔帕明、曲唑酮和氟西汀）。需要进行实验研究，评估这些新药物（具有更有利的副作用）是否能改善依从性，从而改善患者的预后。
Among a sample of 119 distressed high-utilizers of primary care, 45% of patients evaluated by a psychiatrist as needing antidepressant treatment had been treated in the year before the examination. However, only 11% of the patients needing antidepressants had received adequate dosage and duration of pharmacotherapy. In the year following the intervention, study patients whose physicians were advised regarding treatment during a psychiatric consultation were more likely to receive antidepressant medications (52.7%) relative to a randomized control group (36.1%). However, the intervention did not significantly increase the provision of adequate antidepressant therapy (37.1% vs 27.9%). Among study patients using antidepressants, patient characteristics did not differentiate patients who received adequate dosage and duration of antidepressant medications from those who did not. Analysis of data on the duration of antidepressant therapy for all health maintenance organization enrollees initiating use of antidepressants showed that only 20% of patients who had been given prescriptions for first-generation antidepressants (amitriptyline, imipramine, or doxepin) filled four or more prescriptions in the following six months, compared to 34% of patients who had prescriptions for newer antidepressants (nortriptyline, desipramine, trazodone and fluoxetine). Experimental research evaluating whether these newer medications (with more favorable side effect profiles) improve adherence, and thereby patient outcome, is needed.