Depression treatment preferences in older primary care patients
Depression treatment preferences in older primary care patients
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DOI：
10.1093/geront/46.1.14
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发表时间：
2006-02-01
期刊：
影响因子：
5.7
通讯作者：
Unützer, J
中科院分区：
文献类型：
--
作者：
Gum, AM;Areán, PA;Unützer, J
目的：对于老年抑郁症患者，本研究旨在检查(A)与抑郁症治疗偏好相关的特征；(B)预测接受首选治疗的因素；以及(C)接受首选治疗是否预示着满意度和抑郁结果。设计和方法：数据来自1602名抑郁症老年初级护理患者，他们参加了一项多点随机临床试验，比较了常规护理和协作式护理，协作式护理提供长达12个月的药物和咨询。基线评估包括人口统计学、抑郁症、健康信息、既往抑郁症治疗、潜在障碍和治疗偏好(药物、咨询)。在12个月时，评估接受的服务、满意度和抑郁结果。结果：更多的患者更喜欢咨询(57%)而不是药物(43%)。既往治疗类型的经验是偏好的最强预测因素。此外，用药偏好通过男性性别和重度抑郁症的诊断(与恶劣心境相比较)来预测。协作护理模式极大地改善了获得首选治疗的机会，特别是在咨询方面(74%比常规护理的33%)。接受首选治疗并不预示满意或抑郁的结果；这些结果受治疗条件的影响最大。许多抑郁的老年初级保健患者希望得到咨询，而这在普通初级保健中是很少见的。对治疗偏好的讨论应包括对先前治疗经验的评估。增加初级保健和精神卫生专业人员之间合作的协作护理模式可以增加获得首选治疗的机会。如果没有首选的治疗，协作式护理仍然会带来良好的满意度和抑郁结果。
Purpose: For depressed older primary care patients, this study aimed to examine (a) characteristics associated with depression treatment preferences; (b) predictors of receiving preferred treatment; and (c) whether receiving preferred treatment predicted satisfaction and depression outcomes. Design and Methods: Data are from 1,602 depressed older primary care patients who participated in a multisite, randomized clinical trial comparing usual care to collaborative care, which offered medication and counseling for up to 12 months. Baseline assessment included demographics, depression, health information, prior depression treatment, potential barriers, and treatment preferences (medication, counseling). At 12 months, services received, satisfaction, and depression outcomes were assessed. Results: More patients preferred counseling (57%) than medication (43%). Previous experience with a treatment type was the strongest predictor of preference. In addition, medication preference was predicted by male gender and diagnosis of major depression (vs dysthymia). The collaborative care model greatly improved access to preferred treatment, especially for counseling (74% vs 33% in usual care). Receipt of preferred treatment did not predict satisfaction or depression outcomes; these outcomes were most strongly impacted by treatment condition. Implications: Many depressed older primary care patients desire counseling, which is infrequently available in usual primary care. Discussion of treatment preferences should include an assessment of prior treatment experiences. A collaborative care model that increases collaboration between primary care and mental health professionals can increase access to preferred treatment. If preferred treatment is not available, collaborative care still results in good satisfaction and depression outcomes.