Diagnosing depression and prescribing antidepressants by primary care physicians: the impact of practice style variations.
Diagnosing depression and prescribing antidepressants by primary care physicians: the impact of practice style variations.
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初级保健医生诊断抑郁症并开出抗抑郁药：执业风格变化的影响。
DOI：
10.1023/a:1015204401225
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发表时间：
2002
期刊：
影响因子：
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通讯作者：
Mojtabai,Ramin
中科院分区：
文献类型：
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作者：
Mojtabai,Ramin
这项研究调查了初级保健中抑郁障碍的诊断和抗抑郁药物处方的差异，以及医生的执业风格对这些差异的贡献。这些分析是基于对1997年和1998年全国非卧床医疗调查中具有代表性的美国办公室初级保健医生样本的访问。在这个样本中，给出抑郁障碍诊断的倾向和开抗抑郁药的倾向被操作为倾向变量。这些变量是从随机选择的访问每位医生的子样本中获得的，这些变量与相同医生看过的其他患者的诊断和治疗之间的关联进行了检查。结果显示，在不同的实践中，接受抑郁障碍诊断(0-25%)和抗抑郁药物处方(0-38%)的患者的百分比存在很大差异。此外，医生诊断抑郁障碍或开抗抑郁药物的倾向与个别患者的诊断和治疗显著相关。抑郁障碍的诊断和治疗差异很大，实践风格变量对这些差异的重大影响突出表明，需要在初级保健环境中为诊断和治疗抑郁障碍实施统一的实践指南。
This study examined variations in the diagnosis of depressive disorders and prescription of antidepressant medications in primary care and the contribution of the physicians' practice styles to these variations. The analyses were based on visits to a representative sample of the U.S. office-based primary care physicians from the 1997 and 1998 National Ambulatory Medical Care Survey. In this sample, the propensities to give a diagnosis of depressive disorder and to prescribe antidepressants were operationalized as propensity variables. The association of these variables, obtained from a randomly selected subsample of visits to each physician, with the diagnoses and treatments of the other patients seen by the same physicians was examined. The results revealed considerable variations across practices in the percentages of patients who received diagnoses of depressive disorders (0–25%) and prescriptions for antidepressant medications (0–38%). Furthermore, the physicians' propensities to diagnose depressive disorders or to prescribe antidepressants were significantly associated with the diagnosis and treatment of individual patients. The large variations in diagnosis and treatment of depressive disorders and the significant impact of practice style variables on these variations highlight the need for implementation of uniform practice guidelines for diagnosis and treatment of depressive disorders in primary care settings.