Telephone-delivered collaborative care for treating post-CABG depression: a randomized controlled trial.
Telephone-delivered collaborative care for treating post-CABG depression: a randomized controlled trial.
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DOI：
10.1001/jama.2009.1670
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发表时间：
2009-11-18
影响因子：
120.7
通讯作者：
Reynolds, Charles F., III
中科院分区：
文献类型：
--
作者：
Rollman, Bruce L.;Belnap, Bea Herbeck;LeMenager, Michelle S.;Mazumdar, Sati;Houck, Patricia R.;Counihan, Peter J.;Kapoor, Wishwa N.;Schulberg, Herbert C.;Reynolds, Charles F., III
冠状动脉旁路手术(CABG)后抑郁症状通常与较差的临床结果相关。为了测试电话协同护理对冠状动脉搭桥术后抑郁的有效性，与医生通常的护理相比。单盲有效性试验。七家匹兹堡地区的大学和社区医院。302例冠状动脉搭桥术后抑郁患者和151例随机抽样的非抑郁对照组患者在2004年3月至2007年9月期间入选，并作为门诊患者进行随访。为期8个月的电话协作护理，由护士与患者的初级保健医生合作提供，并由研究精神病学家和研究初级保健医生监督。8个月后用SF-36MCS评定精神健康相关生活质量(HRQOL)；二次结局测量包括情绪症状(汉密尔顿抑郁量表(HRS-D))、身体HRQOL(SF-36PCS)和功能(Duke活动状态指数(DASI))；以及再次住院。抑郁症干预组(N=150)在精神生活质量(SF-36MCS：HRS 3.2分；95%CI：0.5-6.0)、身体功能(≤：Δ4.6分；1.9-7.3)和情绪症状(Δ-D：HRS 3.1分(1.3-4.9))方面有更大的改善(均P HRS 0.02)；而且更有可能报告Δ-D评分较基线下降50%(50.0%对29.6%；；NNT4.9(3.2-10.4))，而抑郁症患者被随机分配到医生的常规护理(N=15 2)(P<；0.001)。抑郁男性特别可能从干预中受益(SF-36MCS：Δ5.7点(2.29.2)；P=0.001)，而且往往比接受常规护理的抑郁男性(13%比23%；P=0.07)或抑郁女性(19%比11%；P=0.22)因心血管原因再次住院的几率更低。然而，抑郁干预患者的平均HRQOL和身体功能并没有达到我们非抑郁对照组的水平。与常规护理相比，CABG术后抑郁的电话协作护理在8个月的随访中导致了HRQL、身体功能和情绪症状的改善。
Depressive symptoms commonly follow coronary artery bypass (CABG) surgery and are associated with worse clinical outcomes. To test the effectiveness of telephone-delivered collaborative care for post-CABG depression versus doctors’ usual care. Single-blind effectiveness trial. Seven Pittsburgh-area university-based and community hospitals. 302 depressed post-CABG patients and a non-depressed comparison group of 151 randomly sampled post-CABG patients recruited between 3/2004 and 9/2007 and followed as outpatients. 8-Months of telephone-delivered collaborative care provided by nurses working with patients’ primary care physicians and supervised by a study psychiatrist and study primary care physician. Mental health-related quality of life (HRQoL) as measured by the SF-36 MCS at 8-months follow-up; secondary outcome measures included mood symptoms (Hamilton Rating Scale for Depression (HRS-D)), physical HRQoL (SF-36 PCS) and functioning (Duke Activity Status Index (DASI)); and hospital readmissions. Depressed intervention patients (N=150) reported greater improvements (all P ≤ 0.02) in mental HRQoL (SF-36 MCS: Δ 3.2 points; 95% CI: 0.5–6.0), physical functioning (DASI: Δ 4.6 points; 1.9–7.3), and mood symptoms (HRS-D: Δ3.1 points (1.3–4.9); and were more likely to report a ≥ 50% decline in HRS-D score from baseline (50.0% vs. 29.6%; NNT 4.9 (3.2–10.4)) than depressed patients randomized to their physicians’ usual care (N=152) (P<0.001). Depressed men were particularly likely to benefit from the intervention (SF-36 MCS: Δ 5.7 points (2.2–9.2); P=0.001) and tended to have a lower incidence of rehospitalization for cardiovascular causes than depressed men receiving usual care (13% vs. 23%; P=0.07) or depressed women (19% vs. 11%; P=0.22). However, the mean HRQoL and physical functioning of depressed intervention patients did not reach that of our non-depressed comparison group. Compared to usual care, telephone-delivered collaborative care for post-CABG depression resulted in improved HRQoL, physical functioning, and mood symptoms at 8-months follow-up.
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影响因子：
5.9
作者：
Carney, Robert M.;Freedland, Kenneth E.
通讯作者：
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168.9
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