The quality of care for depressive and anxiety disorders in the United States
The quality of care for depressive and anxiety disorders in the United States
复制标题
DOI：
10.1001/archpsyc.58.1.55
复制
发表时间：
2001-01-01
影响因子：
--
通讯作者：
Wells, KB
中科院分区：
文献类型：
--
作者：
Young, AS;Klap, R;Wells, KB
背景：抑郁症和焦虑症很普遍，并导致相当大的发病率。虽然存在有效的治疗方法，但人们对全国范围内这些疾病的护理质量知之甚少。我们估计了患有这些疾病的美国人群的适当治疗率，以及保险、提供者类型和个人特征对接受适当护理的影响。方法：数据来自1997年至1998年进行的具有全国样本的横断面电话调查。受访者包括1636名成年人，通过简短的诊断性访谈确定可能患有12个月的抑郁症或焦虑症。结果：在一年的时间里，83%的可能患有抑郁症或焦虑症的成年人会去看医生(95%的可信区间[CI]，81%-85%)，30%的人接受了一些适当的治疗(95%的可信区间，28%-33%)。就诊人数最多的只有初级保健提供者。在这一组中，19%的人(95%的可信区间，16%-23%)和90%的去看精神健康专家的个人(95%的可信区间，85%-94%)得到了适当的护理。适当的治疗对于男性和黑人、受教育程度较低、30岁以下或59岁以上(范围为19-97岁)的人来说不太可能。保险和收入对获得适当护理没有影响。结论：可以在全国范围内评估精神卫生保健质量。大多数可能患有抑郁症或焦虑症的成年人没有得到适当的治疗。虽然这在不同的群体中都适用，但适当的护理在某些人口统计亚群中不太常见。
Background: Depressive and anxiety disorders are prevalent and cause substantial morbidity. While effective treatments exist, little is known about the quality of care for these disorders nationally. We estimated the rate of appropriate treatment among the US population with these disorders, and the effect of insurance, provider type, and individual characteristics on receipt of appropriate care.Methods: Data are from a cross-sectional telephone survey conducted during 1997 and 1998 with a national sample. Respondents consisted of 1636 adults with a probable 12-month depressive or anxiety disorder as determined by brief diagnostic interview. Appropriate treatment was defined as present if the respondent had used medication or counseling that was consistent with treatment guidelines.Results: During a 1-year period, 83% of adults with a probable depressive or anxiety disorder saw a health care provider (95% confidence interval [CI], 81%-85%) and 30% received some appropriate treatment (95% CI, 28%-33%). Most visited primary care providers only. Appropriate care was received by 19% in this group (95% CI, 16%-23%) and by 90% of individuals visiting mental health specialists (95% CI, 85%-94%). Appropriate treatment was less likely for men and those who were black, less educated, or younger than 30 or older than 59 years (range, 19-97 years). Insurance and income had no effect on receipt of appropriate care.Conclusions: It is possible to evaluate mental health care quality on a national basis. Most adults with a probable depressive or anxiety disorder do not receive appropriate care for their disorder. While this holds across diverse groups, appropriate care is less common in certain demographic subgroups.