Depression and diabetes -: Impact of depression symptoms on adherence, function, costs
Depression and diabetes -: Impact of depression symptoms on adherence, function, costs
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DOI：
10.1001/archinte.160.21.3278
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发表时间：
2000-11-27
影响因子：
--
通讯作者：
Russo, JE
中科院分区：
文献类型：
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作者：
Ciechanowski, PS;Katon, WJ;Russo, JE
背景：抑郁症在慢性内科疾病患者中很常见。我们探讨了抑郁症状的影响，在初级保健糖尿病患者的糖尿病自我护理，坚持药物治疗方案，功能，和health care costs.Methods：我们管理的问卷调查367例1型和2型糖尿病患者从2个健康维护组织的初级保健诊所，以获得有关人口统计数据，抑郁症状，糖尿病知识，功能，糖尿病自我护理。在自动化数据的基础上，我们测量了医疗合并症、医疗保健费用、糖化血红蛋白（HbA（1c））水平和口服降糖药处方续药。使用抑郁症状严重程度三分位数（低，中，高），我们进行了回归分析，以确定抑郁症状对糖尿病自我护理和口服降糖方案的依从性，HbA（1c）水平，功能障碍和医疗保健费用的影响。结果：与轻度抑郁症状三分位数的患者相比，那些在中等和高严重性三分位数的人明显不太遵守饮食建议。高严重性三分位数的患者与低严重性三分位数的患者有显著差异，因为他们不依从口服降糖方案的天数百分比较高（15%对7%）;较差的身体和精神功能;;有任何急诊科，初级保健，专科护理，医疗住院和心理健康费用的座位概率;在各类保健服务使用者中，（高出51%），非卧床（高出75%），以及医疗保健总成本（高出86%）。抑郁症状的严重程度与较差的饮食和药物治疗方案依从性，功能障碍，以及初级护理糖尿病患者的更高的医疗保健费用。需要进一步的研究来测试糖尿病抑郁症患者的增强护理模式的有效性和成本效益。
Background: Depression is common among patients with chronic medical illness. We explored the impact of depressive symptoms in primary care patients with diabetes on diabetes self-care, adherence to medication regimens, functioning, and health care costs.Methods: We administered a questionnaire to 367 patients with types 1 and 2 diabetes from 2 health maintenance organization primary care clinics to obtain data on demographics, depressive symptoms, diabetes knowledge, functioning, and diabetes self-care. On the basis of automated data, we measured medical comorbidity, health care costs, glycosylated hemoglobin (HbA(1c)) levels, and oral hypoglycemic prescription refills. Using depressive symptom severity tertiles (low, medium, or high), we per formed regression analyses to determine the impact of depressive symptoms on adherence to diabetes self-care and oral hypoglycemic regimens, HbA(1c) levels, functional impairment, and health care costs.Results: Compared with patients in the low-severity depression symptom tertile, those in the medium- and high-severity tertiles were significantly less adherent to dietary recommendations. Patients in the high-severity tertile were significantly distinct from those in the low-severity tertile by having a higher percentage of days in nonadherence to oral hypoglycemic regimens (15% vs 7%); poorer physical and mental functioning;; seater probability of having any emergency department, primary care, specialty care, medical inpatient, and mental health costs; and among users of health care within categories, higher primary (51% higher), ambulatory (75% higher),and total health care costs (86% higher).Conclusions: Depressive symptom severity is associated with poorer diet and medication regimen adherence, functional impairment, and higher health care costs in primary care diabetic patients. Further studies testing the effectiveness and cost-effectiveness of enhanced models of care of diabetic patients with depression are needed.