Implementing collaborative care to reduce depression for rural native American/Alaska native people
Implementing collaborative care to reduce depression for rural native American/Alaska native people
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DOI：
10.1186/s12913-019-4875-6
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发表时间：
2020-01-13
影响因子：
2.8
通讯作者：
Ratzliff, Anna D. H.
中科院分区：
文献类型：
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作者：
Bowen, Deborah J.;Powers, Diane M.;Ratzliff, Anna D. H.
背景本研究的目的是确定合作护理对美国原住民和阿拉斯加原住民（AI/AN）患者的影响。方法在3个AI/AN服务门诊实施协作护理。诊所工作人员参加了旨在促进实践改变的培训和辅导。我们跟踪诊所2年，观察抑郁症治疗的改善，并检查入组患者的治疗结果。协作护理要素包括抑郁症的普遍筛查，循证治疗的目标，使用行为健康护理经理提供干预，使用精神科顾问提供病例咨询，质量改进跟踪，以改善和维持结果。我们使用t检验来评估协作护理的主要效果，并使用多元线性回归来更好地了解成功的预测因素。我们还收集了协作护理临床团队成员关于他们经验的定性数据。结果门诊参与培训和实践辅导，对抑郁症患者实施协同护理。AI/AN患者的抑郁反应（PHQ-9测量的抑郁症状减少50%或更多）和缓解（PHQ-9评分小于5）率与相同诊所的白色患者相当。积极治疗结果的重要预测因素包括研究期间仅一次抑郁症治疗发作和每位患者更多的随访。临床医生对他们的经验和对他们诊所的病人护理的影响总体上是积极的。结论该项目表明，通过农村地区的初级保健机构为AI/AN患者提供协作护理是可能的。
Background The purpose of this study was to identify the effects of Collaborative Care on rural Native American and Alaska Native (AI/AN) patients. Methods Collaborative Care was implemented in three AI/AN serving clinics. Clinic staff participated in training and coaching designed to facilitate practice change. We followed clinics for 2 years to observe improvements in depression treatment and to examine treatment outcomes for enrolled patients. Collaborative Care elements included universal screening for depression, evidence-based treatment to target, use of behavioral health care managers to deliver the intervention, use of psychiatric consultants to provide caseload consultation, and quality improvement tracking to improve and maintain outcomes. We used t-tests to evaluate the main effects of Collaborative Care and used multiple linear regression to better understand the predictors of success. We also collected qualitative data from members of the Collaborative Care clinical team about their experience. Results The clinics participated in training and practice coaching to implement Collaborative Care for depressed patients. Depression response (50% or greater reduction in depression symptoms as measured by the PHQ-9) and remission (PHQ-9 score less than 5) rates were equivalent in AI/AN patients as compared with White patients in the same clinics. Significant predictors of positive treatment outcome include only one depression treatment episodes during the study and more follow-up visits per patient. Clinicians were overall positive about their experience and the effect on patient care in their clinic. Conclusions This project showed that it is possible to deliver Collaborative Care to AI/AN patients via primary care settings in rural areas.