Relationship between depressive symptom severity and emergency department use among low-income, depressed homebound older adults aged 50 years and older.
Relationship between depressive symptom severity and emergency department use among low-income, depressed homebound older adults aged 50 years and older.
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DOI：
10.1186/1471-244x-12-233
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发表时间：
2012-12-26
期刊：
影响因子：
4.4
通讯作者：
Kunik, Mark E
中科院分区：
文献类型：
--
作者：
Choi, Namkee G;Marti, C Nathan;Kunik, Mark E
背景：先前的研究发现，老年ED患者中抑郁症、慢性疾病和残疾的患病率很高。本研究考察了参加远程医疗问题解决疗法（PST）随机对照试验的低收入居家老年人抑郁症状严重程度与ED就诊次数之间的关系。方法：在所有评估点（基线和12周和24周随访）收集研究参与者（基线时n=121）的ED就诊次数和原因。采用24项汉密尔顿抑郁量表（HAMD）测量抑郁症状。检查急诊科就诊与抑郁症状之间关系的所有多变量分析均使用零膨胀泊松回归模型进行。结果：在大约12个月的时间里，67.7%的参与者至少使用过一次ED， 61%的访问者至少进行了一次回访。身体疼痛（不包括摔伤和胸痛）是最常见的原因。基线和随访时的急诊科就诊频率与评估点的HAMD得分显著正相关。在控制基线ED访问的情况下，随访ED访问频率也与基线以来HAMD评分变化显著相关。结论：该组急诊科就诊率远高于其他研究报道。更好的慢性病自我管理教育，初级保健医生和急诊科的抑郁症筛查，以及包括症状管理和解决问题技能在内的抑郁症治疗，可能对减少患病、低收入居家成年人的急诊科就诊很重要。试验注册：ClinicalTrials.gov标识符：NCT00903019。
BACKGROUND: Previous research found a high prevalence of depression, along with chronic illnesses and disabilities, among older ED patients. This study examined the relationship between depressive symptom severity and the number of ED visits among low-income homebound older adults who participated in a randomized controlled trial of telehealth problem-solving therapy (PST).METHODS: The number of and reasons for ED visits were collected from the study participants (n=121 at baseline) at all assessment points-baseline and 12- and 24-week follow-ups. Depressive symptoms were measured with the 24-item Hamilton Rating Scale for Depression (HAMD). All multivariable analyses examining the relationships between ED visits and depressive symptoms were conducted using zero-inflated Poisson regression models.RESULTS: Of the participants, 67.7% used the ED at least once and 61% of the visitors made at least one return visit during the approximately 12-month period. Body pain (not from fall injury and not including chest pain) was the most common reason. The ED visit frequency at baseline and at follow-up was significantly positively associated with the HAMD scores at the assessment points. The ED visit frequency at follow-up, controlling for the ED visits at baseline, was also significantly associated with the HAMD score change since baseline.CONCLUSIONS: The ED visit rate was much higher than those reported in other studies. Better education on self-management of chronic conditions, depression screening by primary care physicians and ED, and depression treatment that includes symptom management and problem-solving skills may be important to reduce ED visits among medically ill, low-income homebound adults.TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT00903019.