Effectiveness of a quality improvement intervention for adolescent depression in primary care clinics - A randomized controlled trial
Effectiveness of a quality improvement intervention for adolescent depression in primary care clinics - A randomized controlled trial
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DOI：
10.1001/jama.293.3.311
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发表时间：
2005-01-19
影响因子：
120.7
通讯作者：
Wells, KB
中科院分区：
文献类型：
--
作者：
Asarnow, JR;Jaycox, LH;Wells, KB
背景抑郁症是一种常见的疾病，与青少年的发病率显著相关。在初级保健机构中，很少有抑郁症青少年接受有效的抑郁症治疗。目的评价旨在增加抑郁症循证治疗途径的质量改进干预措施的有效性（特别是认知行为疗法和抗抑郁药物），相对于常规护理，在青少年的初级保健实践。设计，设置，随机对照试验在1999年至2003年期间进行，招募了418名患有当前抑郁症状的初级保健患者，年龄在13岁至21岁之间，来自5个卫生保健组织，目的是选择包括管理式护理，公共部门，干预性精神病护理（n=207）或6个月的质量改善干预（n=211），包括每个站点的专家、领导团队、支持初级护理临床医生评估和管理患者抑郁症的护理经理、对护理经理进行抑郁症手动认知行为治疗的培训，以及患者和临床医生关于治疗方式的选择。参与的临床医生还接受了教育，抑郁症的评估，管理，药物和心理治疗。主要结果测量抑郁症状的流行病学中心抑郁量表（CES-D）评分评估。次要结果是通过心理健康总分（MCS-12）评估的心理健康相关生活质量和使用5点量表评估的心理健康护理满意度。结果基线评估后6个月，干预患者与常规护理患者相比，抑郁症状明显减少（平均[SD] CES-D评分，19.0 [11.9] vs 21.4 [13.1]; P= 0.02），心理健康相关的生活质量较高（平均[SD] MCS-12评分，44.6 [11.3] vs 42.8 [12.9] P= 0.03），对精神卫生保健的满意度更高（平均[SD]评分3.8 [0.9] vs 3.5 [1.0]; P=.004）。干预组患者的心理健康护理率也明显高于对照组（32.1%比17.2%，P
Context Depression is a common condition associated with significant morbidity in adolescents. Few depressed adolescents receive effective treatment for depression in primary care settings.Objective To evaluate the effectiveness of a quality improvement intervention aimed at increasing access to evidence-based treatments for depression (particularly cognitive-behavior therapy and antidepressant medication), relative to usual care, among adolescents in primary care practices.Design, Setting, and Participants Randomized controlled trial conduced between 1999 and 2003 enrolling 418 primary care patients with current depressive symptoms, aged 13 through 21 years, from 5 health care organizations purposively selected to include managed care, public sector, and academic medical center clinics in the United States.Intervention Usual care (n=207) or 6-month quality improvement intervention (n=211) including expert,leader teams at each site, care managers who supported primary care clinicians in evaluating and managing patients' depression, training for care managers in manualized cognitive-behavior therapy for depression, and patient and clinician choice regarding treatment modality. Participating clinicians also received education regarding depression evaluation, management, and pharmacological and psychosocial treatment.Main Outcome Measures Depressive symptoms assessed by Center for Epidemiological Studies-Depression Scale (CES-D) score. Secondary outcomes were mental health-related quality of life assessed by Mental Health Summary Score (MCS-12) and satisfaction with mental health care assessed using a 5-point scale.Results Six months after baseline assessments, intervention patients, compared with usual care patients reported significantly fewer depressive symptoms (mean [SD] CES-D scores, 19.0 [11.9] vs 21.4 [13.1]; P=.02), higher mental health-related quality of life (mean [SD] MCS-12 scores, 44.6 [11.3] vs 42.8 [12.9] P=.03), and greater satisfaction with mental health care (mean [SD] scores 3.8 [0.9] vs 3.5 [1.0]; P=.004). Intervention patients also reported significantly higher rates of mental health care (32.1% vs 17.2%, P