Treating Depression Within the HIV "Medical Home": A Guided Algorithm for Antidepressant Management by HIV Clinicians
Treating Depression Within the HIV "Medical Home": A Guided Algorithm for Antidepressant Management by HIV Clinicians
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DOI：
10.1089/apc.2012.0113
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发表时间：
2012-11-01
影响因子：
4.9
通讯作者：
Pence, Brian W.
中科院分区：
文献类型：
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作者：
Adams, Julie L.;Gaynes, Bradley N.;Pence, Brian W.
与普通人群相比，艾滋病毒/艾滋病感染者 (PLWHA) 的抑郁症患病率更高，这对抗逆转录病毒 (ART) 依从性和艾滋病毒相关结果产生负面影响，导致发病率和死亡率。然而，这一人群的抑郁症常常得不到诊断和治疗。当前的项目试图设计一种基于证据的方法，将抑郁症护理纳入艾滋病毒诊所。所选择的模型是基于测量的护理（MBC），它基于现有的指南和最大的抑郁症治疗随机试验。 MBC 适应了 HIV 护理的临床现实，用于在三个学术 HIV 诊所进行的抑郁症管理随机对照有效性试验。这种适应措施考虑到了对于持续的 ART 有效性至关重要的药物相互作用，并且可以由非精神卫生服务提供者的多学科团队提供。开发了一种治疗算法，使临床监督的非医生抑郁症护理管理者 (DCM) 能够跟踪和监测抗抑郁药物的耐受性和治疗反应，同时支持非精神科处方者选择抗抑郁药物和剂量。精神科医生每周对 DCM 进行监督，以确保护理质量。在实施过程中非常重要的灵活性的关键领域包括评估时间的灵活性、算法建议和提供者决策之间的分歧的调节以及治疗计划实施延迟的调节。 MBC 模型对 HIV 护理的这种适应解释了重要的抗抑郁药物与抗逆转录病毒相互作用，并促进了 HIV 医疗之家内提供高质量的抗抑郁药物管理。
People living with HIV/AIDS (PLWHA) suffer increased depression prevalence compared to the general population, which negatively impacts antiretroviral (ART) adherence and HIV-related outcomes leading to morbidity and mortality. Yet depression in this population often goes undiagnosed and untreated. The current project sought to design an evidence-based approach to integrate depression care in HIV clinics. The model chosen, measurement-based care (MBC), is based on existing guidelines and the largest randomized trial of depression treatment. MBC was adapted to clinical realities of HIV care for use in a randomized controlled effectiveness trial of depression management at three academic HIV clinics. The adaptation accounts for drug-drug interactions critical to ongoing ART effectiveness and can be delivered by a multidisciplinary team of nonmental health providers. A treatment algorithm was developed that enables clinically supervised, nonphysician depression care managers (DCMs) to track and monitor antidepressant tolerability and treatment response while supporting nonpsychiatric prescribers with antidepressant choice and dosing. Quality of care is ensured through weekly supervision of DCMs by psychiatrists. Key areas of flexibility that have been important in implementation have included flexibility in timing of assessments, accommodation of divergence between algorithm recommendations and provider decisions, and accommodation of delays in implementing treatment plans. This adaptation of the MBC model to HIV care has accounted for critical antidepressant-antiretroviral interactions and facilitated the provision of quality antidepressant management within the HIV medical home.