Treatment Adequacy and Adherence as Predictors of Depression Response in Primary Care.
Treatment Adequacy and Adherence as Predictors of Depression Response in Primary Care.
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DOI：
10.1016/j.jagp.2020.04.014
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发表时间：
2020-11
期刊：
影响因子：
--
通讯作者：
Kales HC
中科院分区：
文献类型：
--
作者：
Sirey JA;Woods A;Solomonov N;Evans L;Banerjee S;Zanotti P;Alexopoulos G;Kales HC
初级保健是美国事实上的精神卫生系统，医生用抗抑郁药物治疗大量抑郁的老年人。本研究旨在研究抗抑郁药剂量充足性和患者依从性是否与初级保健提供者开具抗抑郁药的中老年人群的抑郁反应相关。对从一项随机对照试验中抽取的样本进行了二次分析，该试验将治疗作为依从性干预措施与治疗启动计划进行了比较。治疗启动计划与治疗作为药物相比改善了依从性，但没有改善抑郁症（Sirey等人，2017年）。在这项分析中，我们检查了第6周和第12周的剂量充足性和依从性，作为两组第12周和第24周抑郁反应的预测因素。初级保健实践。187名患有抑郁症的老年人由他们的初级保健提供者开了一种抗抑郁药。抑郁反应定义为汉密尔顿抑郁评定量表降低50%。依从性定义为在随访访视（6周和12周）时服用80%的剂量。在随访时，使用抗抑郁综合评分（适当性评分>3）收集患者报告的抗抑郁治疗剂量和持续时间。在12周（比值比（OR）=2.63; 95%置信区间（CI），1.19-5.84）和24周（OR = 3.09; 95% CI，1.46-6.55）时，更高的依从性，但未接受足够的剂量，与更高的治疗应答可能性相关。由于医生在初级保健中为不同的成年人群体开抗抑郁药，特别注意患者的观点和坚持的方法可能会改善抑郁症的结果。
Primary care is the de facto mental health system in the United States where physicians treat large numbers of depressed older adults with antidepressant medication. This study aimed to examine whether antidepressant dosage adequacy and patient adherence are associated with depression response among middle-aged and older adults prescribed with antidepressants by their primary care provider. A secondary analysis was conducted on a sample drawn from a randomized controlled trial comparing Treatment as Usual to Treatment Initiation Program, an adherence intervention. Treatment Initiation Program improved adherence but not depression compared to Treatment as Usual (Sirey et al., 2017). For this analysis, we examined dosing adequacy and adherence at 6 and 12 weeks as predictors of depression response in both groups at 12 and 24 weeks. Primary care practices. One hundred eighty-seven older adults with depression prescribed an antidepressant for depression by their primary care provider. Depression response was defined as 50% reduction on the Hamilton Rating Scale for Depression. Adherence was defined as taking 80% of doses at follow-up interviews (6 and 12 weeks). Patient-reported dosage and duration of antidepressant therapy was collected using the Composite Antidepressant Score (adequacy score of >3) at follow-up. Greater adherence, but not receipt of adequate dosage, was associated with higher likelihood of treatment response at both 12 (Odds ratio (OR) =2.63; 95% Confidence Interval (CI), 1.19—5.84) and 24 weeks (OR = 3.09; 95% CI, 1.46—6.55). As physicians prescribe antidepressants to the diverse group of adults seen in primary care, special attention to patients’ views and approach to adherence may improve depression outcomes.
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认知控制，与奖励相关的决策和抗抑郁药治疗的后期抑郁症的结果。
影响因子：
6.9
作者：
Alexopoulos GS;Manning K;Kanellopoulos D;McGovern A;Seirup JK;Banerjee S;Gunning F
通讯作者：
Gunning F
DOI：
10.1001/jama.2017.3826
发表时间：
2017-04-18
期刊：
JAMA
影响因子：
--
作者：
Friedrich, M J
通讯作者：
Friedrich, M J
影响因子：
7.2
作者：
Nelson, J. Craig;Delucchi, Kevin;Schneider, Lon S.
通讯作者：
Schneider, Lon S.
影响因子：
39
作者：
Choudhry, Niteesh K.;Krumme, Alexis A.;Franklin, Jessica M.
通讯作者：
Franklin, Jessica M.
影响因子：
3.8
作者：
Maust, Donovan T.;Sirey, Jo Anne;Kales, Helen C.
通讯作者：
Kales, Helen C.