Variation In The Effectiveness Of Collaborative Care For Depression: Does It Matter Where You Get Your Care?
Variation In The Effectiveness Of Collaborative Care For Depression: Does It Matter Where You Get Your Care?
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DOI：
10.1377/hlthaff.2019.01714
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发表时间：
2020-11-01
期刊：
影响因子：
9.7
通讯作者：
Russo, Joan
中科院分区：
文献类型：
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作者：
Unutzer, Jurgen;Carlo, Andrew C.;Russo, Joan
随机对照试验表明，初级保健中抑郁症的协作护理模式比常规护理更有效，但人们对这种方法在现实环境中的有效性知之甚少。我们使用了来自135个初级保健诊所的11，303名接受抑郁症协作治疗的患者的患者报告结果数据，以检查抑郁症结果的变化。这个大样本诊所的平均治疗反应大大低于随机对照试验中报告的反应率，观察到显著的结局差异。患者因素，如初始抑郁症的严重程度，临床因素，如合作护理实践的年数，以及实施支持的程度与抑郁症的结果在随访。我们的研究结果表明，实施支持的水平可能是一个重要的影响，合作护理模式计划的有效性。
Randomized controlled trials have demonstrated that the collaborative care model for depression in primary care is more effective than usual care, but little is known about the effectiveness of this approach in real-world settings. We used patient-reported outcome data from 11,303 patients receiving collaborative care for depression in 135 primary care clinics to examine variations in depression outcomes. The average treatment response across this large sample of clinics was substantially lower than response rates reported in randomized controlled trials, and substantial outcome variation was observed. Patient factors such as initial depression severity, clinic factors such as the number of years of collaborative care practice, and the degree of implementation support received were associated with depression outcomes at follow-up. Our findings suggest that the level of implementation support could be an important influence on the effectiveness of collaborative care model programs.