Treatment of depression in older primary care patients in health maintenance organizations
Treatment of depression in older primary care patients in health maintenance organizations
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DOI：
10.2190/vkbr-1ar6-9nbd-0n25
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发表时间：
1997-01-01
影响因子：
2
通讯作者：
Levine, K
中科院分区：
文献类型：
--
作者：
Bartels, SJ;Horn, S;Levine, K
目的：研究老年HMO抑郁症患者在诊断、专科提供者的治疗和药物治疗方面是否与年轻患者不同。设计：图表回顾、横断面研究。地点和参与者：患者选自美国的六家医疗保健组织，他们有五种或五种以上的医学诊断：关节炎、哮喘、中耳炎、上腹痛/溃疡和高血压(It 9143)。在这组患者中，使用图表诊断和药学记录来确定也被诊断为抑郁症(n=416)或被诊断为抑郁症和/或接受抗抑郁药物治疗的患者(n=1286)。测量：审查医疗记录和计算机化的服务和药房记录，以获得诊断、按提供者类型进行的办公室访问以及精神科药物处方计数。结果：老年患者与年轻患者在治疗抑郁症方面存在显著差异。尽管在两组患者中发现了抑郁症，但老年患者接受的精神健康专科就诊较少，开出的SSRI抗抑郁药处方也较少。被诊断为抑郁症的老年患者更有可能接受苯二氮类药物的治疗(49.2%的老年患者对33.2%的年轻患者)，尽管他们不太可能接受长半衰期的苯二氮卓类药物治疗。结论：精神科药物管理是提高HMOS老年抑郁症患者护理质量的重要目标。减少无效的小镇静剂的使用，增加新型抗抑郁药物的使用，可能会改善老年抑郁症患者的预后。
Objective: To examine whether older HMO patients with depression are treated differently than younger patients in terms of diagnosis, treatment by specialty provider, and pharmacotherapy. Design: Chart-review, Cross sectional study. Settings and Participants: Patients were selected from six HMOs in the United States who had one or more of five medical diagnoses: arthritis, asthma, otitis media, epigastric pain/ulcer, and hypertension, (It 9143). From this group, chart diagnoses and pharmacy records were used to identify patients who also had a diagnosis of depression (n = 416) or who had a diagnosis of depression and/or treatment with antidepressant medication (n = 1286). Measurements: Medical records and computerized service and pharmacy records were reviewed to obtain diagnoses, office visits by provider type, and psychiatric medication prescription counts. Results: Significant differences were found in treatment of depression for older versus younger patients. Although depression was identified at a similar I ate for both groups, older patients received fewer mental health specialty visits and fewer prescriptions for SSRI antidepressants. Older patients with a diagnosis of depression were more likely to be treated with benzodiazepines (49.2% of older vs. 33.2% of younger) though they were less likely to receive long half-life benzodiazepines. Conclusions: Psychotropic medication management is an important target for improving quality of care for older patients with depression in HMOs. Decreasing inefficient minor tranquilizer use and increasing use of newer antidepressant medications may lead to improved outcomes for older depressed adults.