Variations in the probability of depression screening at community-based physician practice visits.
Variations in the probability of depression screening at community-based physician practice visits.
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DOI：
10.4088/pcc.09m00911blu
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发表时间：
2010-01-01
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影响因子：
--
通讯作者：
Touchet, Bryan K
中科院分区：
文献类型：
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作者：
Harrison, Donald L;Miller, Michael J;Touchet, Bryan K
背景：尽管抑郁症筛查是美国预防服务工作组推荐的初级保健做法，但人们对抑郁症筛查的执行程度以及与其行为相关的因素知之甚少。 方法：使用 2005 年至 2007 年调查期间成人、社区医生实践就诊的全国代表性样本（国家流动医疗调查）（总数 = 55,143；代表全国约 17 亿次就诊），我们估计了抑郁症筛查和筛查的可能性。因就诊特征而异。结果：在成人社区医生执业就诊中，有 2.29% 进行了抑郁症筛查。与急性护理就诊相比，初级保健医生的就诊更有可能包括抑郁症筛查（AOR = 2.19；95% CI，1.31-3.65），预防性就诊（AOR = 4.09；95% CI，2.55-6.57）和慢性护理（AOR = 2.00；95% CI，1.44-2.80）。与东北地区相比，西部地区的就诊中包含抑郁症筛查的可能性较小（AOR = 0.27；95% CI，0.13-0.57），与新患者就诊相比，过去 12 个月内就诊次数≥ 6 次的患者也包含抑郁症筛查（AOR = 0.65；95% CI，0.42-1.00）。对于 ICD-9 诊断的抑郁症患者（AOR = 7.51；95% CI，5.38-10.50）和女性（AOR = 1.26；95% CI，1.00-1.57），抑郁症筛查更为常见。双变量分析显示，抑郁症筛查在患有高脂血症（3.21% vs 2.09%，P = .0086）、肥胖（4.59% vs 2.08%，P < .0001）和骨质疏松症（4.46% vs 2.21%，P = .0002）的患者就诊时更为常见，而在糖尿病患者就诊时则不太常见（1.58% vs 2.08%，P < .0002）。 2.39%，P = .0102）。结论：美国社区医生就诊时的抑郁症筛查似乎较低（2.29%），可能反映了已发布指南中未定义的最佳筛查间隔或策略、缺乏报销激励措施或病历中的记录不完整。改善男性、慢性病（尤其是糖尿病）患者和美国西部地区抑郁症筛查的机会是存在的。
BACKGROUND: Despite depression screening being a US Preventive Services Task Force-recommended practice in primary care, little is known about the degree to which it is performed and the factors associated with its conduct.METHOD: Using a nationally representative sample (National Ambulatory Medical Care Survey) of adult, community-based physician practice visits during the survey years 2005 to 2007 (total = 55,143; representing approximately 1.7 billion visits nationally), we estimated the probability of depression screening and variation by visit characteristics.RESULTS: Depression screening occurred at 2.29% of adult, community-based physician practice visits. Visits with primary care physicians were more likely to include depression screening (AOR = 2.19; 95% CI, 1.31-3.65), as were visits for preventive (AOR = 4.09; 95% CI, 2.55-6.57) and chronic care (AOR = 2.00; 95% CI, 1.44-2.80) compared to visits for acute care. Compared to the Northeast, visits in the West were less likely to include depression screening (AOR = 0.27; 95% CI, 0.13-0.57), as were visits for patients having ≥ 6 visits within the past 12 months (AOR = 0.65; 95% CI, 0.42-1.00) when compared to visits for new patients. Depression screening was more common at visits for patients with ICD-9-diagnosed depression (AOR = 7.51; 95% CI, 5.38-10.50) and for females (AOR = 1.26; 95% CI, 1.00-1.57). Bivariate analyses revealed that depression screening was more common at visits for patients with hyperlipidemia (3.21% vs 2.09%, P = .0086), obesity (4.59% vs 2.08%, P < .0001), and osteoporosis (4.46% vs 2.21%, P = .0002) and less common at visits for patients with diabetes (1.58% vs 2.39%, P = .0102).CONCLUSIONS: Depression screening at community-based physician practice visits in the United States appears to be low (2.29%) and may reflect an undefined optimal screening interval or strategy in published guidelines, lack of reimbursement incentives, or incomplete documentation in the medical record. Opportunities exist to improve depression screening in males, patients with chronic disease (especially diabetes), and the western region of the United States.