The Association Between Rural Residence and the Use, Type, and Quality of Depression Care
The Association Between Rural Residence and the Use, Type, and Quality of Depression Care
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DOI：
10.1111/j.1748-0361.2010.00290.x
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发表时间：
2010-06-01
影响因子：
4.9
通讯作者：
Dong, Fran
中科院分区：
文献类型：
--
作者：
Fortney, John C.;Harman, Jeffrey S.;Dong, Fran
目的：为了评估农村和抑郁症care.Methods之间的关联：数据被提取为10,319个人与自我报告的抑郁症的医疗费用面板调查。药物治疗定义为抗抑郁药处方填充，最低限度充分药物治疗定义为接受至少4次抗抑郁药填充。心理治疗被定义为门诊咨询访问，最低限度的充分心理治疗被定义为≥ 8次访问。使用大都市统计区（MSAs）和农村城市连续代码（RUCCs）的定义，农村：在过去的一年中，65.1%的抑郁症接受治疗，其中58.8%至少有一个抗抑郁药处方填写和24.5%至少有一个心理治疗访问。在接受治疗的患者中，56.2%的患者接受了最低限度的药物治疗，36.3%的患者接受了最低限度的心理治疗。总体而言，在接受任何类型的正式抑郁症治疗方面，城乡之间没有显着差异。然而，居住在农村与接受药物治疗的几率显著较高相关（MSA：OR 1.16 [95%CI，1.01-1.34; P = .04]和RUCC：OR 1.04 [95%CI，1.00-1.08; P = .05]），接受心理治疗的几率显著降低（MSA：OR 0.62 [95% CI，0.53-0.74; P < .01]和RUCC：OR 0.91 [95% CI，0.88-0.94; P < .001]）。农村居住与药物治疗的充分性无显著相关性，但与心理治疗的充分性显著相关（MSA：OR 0.53 [95%CI，0.41-0.69; P <0.01]和RUCC：OR 0.92 [95%CI，0.86-0.99; P = 0.02]）。精神科医生人均是一个调解员的心理治疗analysis.Conclusions：农村个人更依赖于药物治疗比心理治疗。如果农村地区的个人因为没有心理治疗师而不是因为他们更喜欢药物治疗而转向药物治疗，这可能是一个令人关切的问题。
Objective: To assess the association between rurality and depression care.Methods: Data were extracted for 10,319 individuals with self-reported depression in the Medical Expenditure Panel Survey. Pharmacotherapy was defined as an antidepressant prescription fill, and minimally adequate pharmacotherapy was defined as receipt of at least 4 antidepressant fills. Psychotherapy was defined as an outpatient counseling visit, and minimally adequate psychotherapy was defined as >= 8 visits. Rurality was defined using Metropolitan Statistical Areas (MSAs) and Rural Urban Continuum Codes (RUCCs).Results: Over the year, 65.1% received depression treatment, including 58.8% with at least 1 antidepressant prescription fill and 24.5% with at least 1 psychotherapy visit. Among those in treatment, 56.2% had minimally adequate pharmacotherapy treatment and 36.3% had minimally adequate psychotherapy treatment. Overall, there were no significant rural-urban differences in receipt of any type of formal depression treatment. However, rural residence was associated with significantly higher odds of receiving pharmacotherapy (MSA: OR 1.16 [95% CI, 1.01-1.34; P = .04] and RUCC: OR 1.04 [95% CI, 1.00-1.08; P = .05]), and significantly lower odds of receiving psychotherapy (MSA: OR 0.62 [95% CI, 0.53-0.74; P < .01] and RUCC: OR 0.91 [95% CI, 0.88-0.94; P < .001]). Rural residence was not significantly associated with the adequacy of pharmacotherapy, but it was significantly associated with the adequacy of psychotherapy (MSA: OR 0.53 [95% CI, 0.41-0.69; P < .01] and RUCC: OR 0.92 [95% CI, 0.86-0.99; P = .02]). Psychiatrists per capita were a mediator in the psychotherapy analyses.Conclusions: Rural individuals are more reliant on pharmacotherapy than psychotherapy. This may be a concern if individuals in rural areas turn to pharmacotherapy because psychotherapists are unavailable rather than because they have a preference for pharmacotherapy.