Primary care physicians' medical decision making for late-life depression
Primary care physicians' medical decision making for late-life depression
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DOI：
10.1007/bf02642478
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发表时间：
1996-04-01
影响因子：
5.7
通讯作者：
Tierney, WM
中科院分区：
文献类型：
--
作者：
Callahan, CM;Dittus, RS;Tierney, WM
目的：描述初级保健医生关于晚年抑郁症的临床决策。设计：纵向收集关于医生临床评估和患者门诊就诊的数量和内容的数据，作为医生靶向干预改善晚年抑郁症治疗的随机临床试验的一部分。111名初级保健医生完成了一份结构化问卷，描述了他们对222名老年患者的临床评估，这些患者在筛选问卷上报告了抑郁症状。干预医生在完成关于其临床评估的问卷调查之前，获得患者的汉密尔顿抑郁量表（HAM-D）评分和针对患者的治疗建议。那些没有提供HAM-D评分的医生同样可能将他们的患者评定为抑郁，这是通过对这些医生关于他们的临床评估的具体询问来确定的。医生对可能抑郁的临床评级并不总是导致治疗意图或行动的制定。治疗算法的提供促进了治疗意图和行动，但医生打算治疗的患者中只有不到一半接受了治疗。治疗障碍似乎包括医生和患者对治疗益处的怀疑。结论：缺乏对抑郁症状的认识似乎并不是治疗的主要障碍。识别症状和获得治疗算法并不总是导致进展到治疗决策的后续阶段。需要更多的研究来确定患者和医生如何权衡治疗的潜在风险和益处，以及他们做出这些判断的准确性。
OBJECTIVE: To describe primary care physicians' clinical decision making regarding late-life depression.DESIGN: Longitudinal collection of data regarding physicians' clinical assessments and the volume and content of patients' ambulatory visits as part of a randomized clinical trial of a physician-targeted intervention to improve the treatment of late-life depression.SETTING: Academic primary care group practice.PATIENTS/PARTICIPANTS: One-hundred and eleven primary care physicians who completed a structured questionnaire to describe their clinical assessments immediately following their evaluations of 222 elderly patients who had reported symptoms of depression on screening questionnaires.INTERVENTIONS: Intervention physicians were provided with their patient's score on the Hamilton Depression rating scale (HAM-D) and patient-specific treatment recommendations prior to completing the questionnaire regarding their clinical assessment.MAIN RESULTS: Those physicians not provided HAM-D scores were just as likely to rate their patients as depressed, as determined by specific query of these physicians regarding their clinical assessments, A physician's clinical rating of likely depression did not consistently result in the formulation of treatment intentions or actions. Treatment intentions and actions were facilitated by provision of treatment algorithms, but treatment was received by fewer than half of the patients whom physicians intended to treat. Barriers to treatment appear to include both physician and patient doubts about treatment benefits.CONCLUSIONS: Lack of recognition of depressive symptoms did not appear to be the primary barrier to treatment. Recognition of symptoms and access to treatment algorithms did not consistently result in progression to subsequent stages in treatment decision making. More research is needed to determine how patients and physicians weigh the potential risks and benefits of treatment and how accurately they make these judgments.