The process and outcomes of care for major depression in rural family practice settings.
The process and outcomes of care for major depression in rural family practice settings.
复制标题
农村家庭实践环境中重性抑郁症护理的过程和结果。
DOI：
10.1111/j.1748-0361.1995.tb00404.x
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发表时间：
1995
期刊：
影响因子：
--
通讯作者：
SmithJr,GR
中科院分区：
文献类型：
--
作者：
Rost,K;Williams,C;Wherry,J;SmithJr,GR
尽管初级保健医生为农村重度抑郁症患者提供了大部分护理，但人们对他们提供的护理质量知之甚少。本研究的目的是表征农村重性抑郁症患者的护理过程和结果，并检查该人群护理过程和结果之间的关系。对来自小城镇21个初级保健诊所的631名患者进行了筛查；47名符合DSM - III - R当前重度抑郁症标准的患者（占筛查患者的7.4%）被招募到研究中，38名患者（占招募患者的81.0%）在使用抑郁结局模块（Rost, Smith, Burnam, & Burns, 1992）平均随访5个月后。在38名抑郁症患者中，有24人（63.1%）在第一次访问和随访之间接受了一种或多种抗抑郁药物的处方，只有11人（28.9%）接受了符合卫生保健政策和研究机构（AHCPR）新指南的药物治疗；38例抑郁症患者中有26例（68.4%）在5个月时仍符合重度抑郁症的标准。那些接受符合AHCPR指南的药物治疗的患者在随访中表现出更大的改善。研究结果表明，在农村家庭实践环境中，重度抑郁症的结果可能比在城市环境中更糟。该研究还表明，AHCPR指南在研究样本中确定了重度抑郁症的有效治疗方法。抑郁结果模块似乎是一种可靠和有效的工具，用于监测家庭实践环境中严重抑郁症的护理结果。
Although primary care physicians provide the majority of care for rural residents with major depression, little is known about the quality of the care they provide. The aim of this study was to characterize the process and outcomes of care for rural patients with major depression, and to examine the relationship between the process and outcomes of care in this population. Six hundred and thirty‐one patients in 21 primary care practices in small towns were screened; 47 patients (7.4% of patients screened) meeting DSM‐III‐R criteria for current major depression were recruited into the study, and 38 (81.0% of patients recruited) were followed an average of five months later using the Depression Outcomes Module (Rost, Smith, Burnam, & Burns, 1992). While 24 (63.1%) of the 38 depressed subjects received a prescription for one or more antidepressants between the index visit and follow‐up, only 11 (28.9%) received pharmacologic treatment in concordance with the new Agency for Health Care Policy and Research (AHCPR) guidelines; 26 (68.4%) of 38 depressed patients continued to meet criteria for major depression at five months. Those who received pharmacologic treatment concordant with AHCPR guidelines showed more improvement at follow‐up. The findings suggest that outcomes for major depression may be worse in rural family practice settings than in urban settings. The study also demonstrates that AHCPR guidelines define effective treatment for major depression in the study sample. The Depression Outcomes Module appears to be a reliable and valid instrument for monitoring the outcomes of care for major depression in family practice settings.