The Bypassing the Blues treatment protocol: stepped collaborative care for treating post-CABG depression.
The Bypassing the Blues treatment protocol: stepped collaborative care for treating post-CABG depression.
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DOI：
10.1097/psy.0b013e3181970c1c
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发表时间：
2009-02
影响因子：
3.3
通讯作者：
Reynolds CF 3rd
中科院分区：
文献类型：
--
作者：
Rollman BL;Belnap BH;LeMenager MS;Mazumdar S;Schulberg HC;Reynolds CF 3rd
介绍消除忧郁（BtB）研究的设计，以检查协作护理策略对治疗心脏病患者抑郁症的影响。冠状动脉旁路移植术（CABG）手术是美国最常见和最昂贵的医疗程序之一。多达一半的CABG术后患者报告抑郁症状，他们更有可能经历更差的健康相关生活质量（HRQoL）、更差的功能状态、持续胸痛和更高的心血管发病风险，这些风险与心脏状态、医疗合并症和搭桥手术的程度无关。BtB设计入组了来自8家爱丁堡地区医院的450例CABG后患者，包括：（1）300例在出院前和住院后2周表现出情绪症状的患者（患者健康问卷（PHQ-9）≥10）;（2）150例作为非抑郁对照（PHQ-9 <5）的患者。抑郁症患者被随机分为两组，一组接受为期8个月的护士电话协作护理，由精神科医生和初级保健专家监督，另一组接受医生的“常规护理”。主要假设将检验干预是否可以在CABG后8个月时产生HRQoL改善≥0.5的效应量，通过SF-36精神健康总评量表进行测量。次要假设将检查我们的干预对情绪症状，心血管疾病发病率，就业，卫生服务利用和治疗费用的影响。不适用因这项有效性试验将提供关于广泛推广的循证协作护理策略对治疗患有心脏病的抑郁症患者的影响的关键信息。
To present the design of the Bypassing the Blues (BtB) study to examine the impact of a collaborative care strategy for treating depression among patients with cardiac disease. Coronary artery bypass graft (CABG) surgery is one of the most common and costly medical procedures performed in the US. Up to half of post-CABG patients report depressive symptoms, and they are more likely to experience poorer health-related quality of life (HRQoL), worse functional status, continued chest pains, and higher risk of cardiovascular morbidity independent of cardiac status, medical comorbidity, and the extent of bypass surgery. BtB was designed to enroll 450 post-CABG patients from eight Pittsburgh-area hospitals including: (1) 300 patients who expressed mood symptoms preceding discharge and at 2 weeks post hospitalization (Patient Health Questionnaire (PHQ-9) ≥10); and (2) 150 patients who served as nondepressed controls (PHQ-9 <5). Depressed patients were randomized to either an 8-month course of nurse-delivered telephone-based collaborative care supervised by a psychiatrist and primary care expert, or to their physicians’ “usual care.” The primary hypothesis will test whether the intervention can produce an effect size of ≥0.5 improvement in HRQoL at 8 months post CABG, as measured by the SF-36 Mental Component Summary score. Secondary hypotheses will examine the impact of our intervention on mood symptoms, cardiovascular morbidity, employment, health services utilization, and treatment costs. Not applicable. This effectiveness trial will provide crucial information on the impact of a widely generalizable evidence-based collaborative care strategy for treating depressed patients with cardiac disease.