Optimizing Outcomes for Patients with Depression and Chronic Medical Illnesses
Optimizing Outcomes for Patients with Depression and Chronic Medical Illnesses
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DOI：
10.1016/j.amjmed.2008.09.012
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发表时间：
2008-11-01
影响因子：
5.9
通讯作者：
Ford, Daniel E.
中科院分区：
文献类型：
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作者：
Ford, Daniel E.
抑郁症和并发的慢性疾病如冠心病、糖尿病和骨关节炎在初级保健机构中很常见，这些疾病的相互作用会使诊断和治疗工作复杂化。虽然这些双向关联的病因尚不清楚，但一些负面结果是明显的，并且在患者，提供者和医疗保健系统层面存在挑战，以更好地识别和治疗慢性医疗合并症患者的抑郁症。这类患者更有可能出现身体上的抱怨，从事不健康的行为，怀有不健康的想法或认知，并且不太可能遵守治疗建议。初级保健接触通常是这些患者解决这些问题并获得其抑郁症所需的专业关注的唯一机会。对于临床医生来说，与患者建立共情伙伴关系，开出适当的治疗处方，密切监测症状和治疗进展，对于情感和医学障碍的最佳管理都是非常宝贵的。在卫生保健系统层面也存在进一步改善护理的机会，例如在初级保健环境中开发、资助和实施多模式协作护理模式。(C) 2008年Elsevier Inc.出版美国医学杂志（2008）121,338 - s44
Depression and comorbid chronic medical conditions such as coronary heart disease, diabetes mellitus, and osteoarthritis are frequently seen in the primary care setting, and the interaction of these illnesses can complicate diagnostic and treatment efforts. Although the etiologies of these bidirectional associations are not well understood, a number of negative outcomes are apparent, and challenges exist at patient, provider, and healthcare system levels to better recognize and treat depression in patients with chronic medical comorbidity. Such patients are more likely to present with somatic complaints, engage in unhealthy behaviors, harbor unhealthy thoughts or cognitions, and are less likely to comply with therapeutic recommendations. Primary care encounters often represent the only opportunities for these patients to address these issues and obtain the professional attention their depression requires. For clinicians, forging empathetic partnerships with patients, prescribing appropriate treatments, and closely monitoring symptoms and therapeutic progress are invaluable for optimal management of both affective and medical disorders. Further opportunities to improve care also exist at the healthcare system level, such as developing, funding, and implementing multimodal collaborative care models in the primary care setting. (C) 2008 Published by Elsevier Inc. The American Journal of Medicine (2008) 121, S38-S44