Improving depression outcomes in community primary care practice - A randomized trial of the QuEST intervention
Improving depression outcomes in community primary care practice - A randomized trial of the QuEST intervention
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DOI：
10.1046/j.1525-1497.2001.00537.x
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发表时间：
2001-03-01
影响因子：
5.7
通讯作者：
Duan, NH
中科院分区：
文献类型：
--
作者：
Rost, K;Nutting, P;Duan, NH
目的：为了确定是否重新定义初级保健团队的角色将改善患者开始一个新的治疗情节为major depression.DESIGN：分层后，6的12个做法被随机分配到干预条件。干预效果通过患者6个月内抑郁症状和功能状态100分量表的变化进行评估。设置：全国12个社区初级保健机构，不雇用现场精神卫生专业人员。患者：采用两阶段筛选，纳入479例抑郁症成年患者（73.4%的合格者）; 90.2%完成了6个月的随访。干预：两名初级保健医生，一名护士，和一名行政人员在每个干预实践接受了简短的培训，以提高检测和管理的重性抑郁症。在开始新一轮治疗的患者中，干预措施使抑郁症状改善了8.2分（95%置信区间[CI]，0.2至16.1：P= 0.04），在该组中，干预改善了抑郁症状16.2分（95% CI，4.5 - 27.9; P = 0.007），身体角色功能提高14.1分（95% CI，1.1 - 29.2; P = 0.07），对治疗的满意度（P = 0.02）。已经在治疗的患者在登记并没有受益于intervention.CONCLUSIONS：在实践中没有现场的心理健康专业人员，简短的干预培训初级保健团队承担重新定义的角色可以显着改善抑郁症患者的结果开始一个新的治疗事件。这种干预措施应该针对那些报告抗抑郁药物是其病情可接受的治疗的患者。需要更多的研究来确定初级保健团队如何能够最好地维持这些重新定义的角色。
OBJECTIVE: To determine whether redefining primary care team roles would improve outcomes for patients beginning a new treatment episode for major depression.DESIGN: Following stratification, 6 of 12 practices were randomly assigned to the intervention condition. Intervention effectiveness was evaluated by patient reports of 6-month change in 100-point depression symptom and functional status scales.SETTING: Twelve community primary care practices across the country employing no onsite mental health professional.PATIENTS: Using two-stage screening, practices enrolled 479 depressed adult patients (73.4% of those eligible); 90.2% completed six-month follow-up.INTERVENTION: Two primary care physicians, one nurse, and one administrative staff member in each intervention practice received brief training to improve the detection and management of major depression.MAIN RESULTS: In patients beginning a new treatment episode, the intervention improved depression symptoms by 8.2 points (95% confidence interval [CI], 0.2 to 16.1: P=.04), Within this group, the intervention improved depression symptoms by 16.2 points (95% CI, 4.5 to 27.9; P =.007), physical role functioning by 14.1 points (95% CI, 1.1 to 29.2; P =.07], and satisfaction with care (P =.02) for patients who reported antidepressant medication was an acceptable treatment at baseline. Patients already in treatment at enrollment did not benefit from the intervention.CONCLUSIONS: In practices without onsite mental health professionals, brief interventions training primary care teams to assume redefined roles can significantly improve depression outcomes in patients beginning a new treatment episode. Such interventions should target patients who report that antidepressant medication is an acceptable treatment for their condition. More research is needed to determine how primary care teams can best sustain these redefined roles over time.