Comorbid chronic illness and the diagnosis and treatment of depression in safety net primary care settings.
Comorbid chronic illness and the diagnosis and treatment of depression in safety net primary care settings.
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DOI：
10.3122/jabfm.2009.02.080035
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发表时间：
2009-03
期刊：
影响因子：
--
通讯作者：
Baker RS
中科院分区：
文献类型：
--
作者：
Ani C;Bazargan M;Hindman D;Bell D;Rodriguez M;Baker RS
评估慢性疾病对抑郁症诊断、治疗和初级保健机构随访护理的影响。这是一项横断面研究，使用了访谈者管理的调查和医疗记录审查。从3个公共初级保健诊所招募了315名参与者。与使用查尔森合并症指数（CCI）测量的抑郁症和慢性疾病患者相比，抑郁症诊断、符合指南的治疗和随访护理是单独患有抑郁症的患者的主要结局。医生诊断抑郁症（32.6%），指南一致的抑郁症治疗（32.7%），和指南一致的后续护理（16.3%）都很低。Logistic回归分析显示，与那些同时患有抑郁症和慢性疾病的人相比，单独患有抑郁症的人在抑郁症诊断、指南一致性治疗或随访护理的可能性方面没有显著差异。然而，重度抑郁症患者被诊断为抑郁症的可能性是中度抑郁症患者的两倍。此外，中度和重度抑郁症的参与者比中度抑郁症的参与者接受的适当后续护理要少得多。在接受抑郁症诊断的参与者中，74%接受了与指南一致的治疗。在初级保健环境中，医生的抑郁症护理不受其他共病医疗条件的竞争需求的影响。
To estimate the impact of chronic medical conditions on depression diagnosis, treatment, and follow-up care in primary care settings. This was a cross-sectional study that used interviewer-administered surveys and medical record reviews. Three hundred fifteen participants were recruited from 3 public primary care clinics. Depression diagnosis, guideline-concordant treatment, and follow-up care were the primary outcomes examined in individuals with depression alone compared with individuals with depression and chronic medical conditions measured using the Charlson Comorbidity Index (CCI). Physician diagnosis of depression (32.6%), guideline-concordant depression treatment (32.7%), and guideline-concordant follow-up care (16.3%) were all low. Logistic regression analysis showed no significant difference in the likelihood of depression diagnosis, guideline-concordant treatment, or follow-up care in individuals with depression alone compared with those with both depression and chronic medical conditions. Participants with severe depression were, however, twice as likely to receive a diagnosis of depression as participants with moderate depression. In addition, participants with moderately severe and severe depression received much less appropriate follow-up care than participants with moderate depression. Among participants receiving a depression diagnosis, 74% received guideline-concordant treatment. Physician depression care in primary care settings is not influenced by competing demands for care for other comorbid medical conditions.
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影响因子：
5.1
作者：
Fan, Amy Z.;Strine, Tara W.;Mokdad, Ali H.
通讯作者：
Mokdad, Ali H.
DOI：
10.1046/j.1532-5415.2003.51506.x
发表时间：
2003-11-01
影响因子：
6.3
作者：
Fischer, LR;Wei, FF;Heinrich, RL
通讯作者：
Heinrich, RL
影响因子：
158.5
作者：
Kessler, RC;Demler, O;Zaslavsky, AM
通讯作者：
Zaslavsky, AM
影响因子：
7
作者：
Brown, C;Schulberg, HC;Prigerson, HG
通讯作者：
Prigerson, HG
影响因子：
6.6
作者：
de Jonghe, F;Kool, S;Peen, J
通讯作者：
Peen, J