Detecting and Managing depression in primary care

抑郁症在美国印第安人和阿拉斯加土著人(AI/ANS)中很常见。更多的人工智能/人工智能在 普通医疗诊所而不是精神健康环境，在那里，初级保健通常不会发现抑郁症 供应商。只有适度的随访率，如抗抑郁药配药和心理健康转介 一旦检测到。已经开发了治疗指南来改进抑郁症的检测和治疗， 但供应商的遵从性在很大程度上没有受到审查。2001年3月，南中央基金会(阿拉斯加的一家 土著卫生保健组织)实施了一项全面的抑郁症筛查倡议，名为 《抑郁症协作组》该倡议要求对所有初级保健就诊的成年门诊患者进行筛查 该组织位于阿拉斯加土著医疗中心园区的家庭医学诊所的提供者。这个 倡议被认为是管理上的成功，完成率为60%，但人们仍然担心 40%的患者的需求没有得到筛查。该诊所还实施了诊疗 根据抑郁症严重程度的不同而不同的指南。在这里，供应商的遵守情况也是未知的。给定 关于围绕这一及时倡议的重要问题，研究项目3的具体目标是： 1)描述AI/ANS中与遗漏抑郁症筛查相关的患者和提供者特征 在初级保健方面。 2)描述筛查抑郁症阳性的AI/ANS的人口学和临床特征。 3)确定当AI/ANS筛查结果为阳性时，提供者注意或诊断抑郁症的频率 仪器，以及与记数和诊断相关的变量，以及 4)评估提供者遵守治疗方案的频率和影响依从性的因素。 该研究计划分两个独立但相关的阶段来解决这些目标。第一阶段的重点是 检测过程，包括目标1和目标2。第二阶段侧重于管理 过程，包括目标3和目标4。 这项努力将是第一次有足够的样本量来洞察差异的研究 初级保健环境中抑郁症状按年龄、性别和临床特征的分布。它 也将第一次检查抑郁症筛查和治疗指南的有效性 AI/An人口。

Depression is common among American Indians and Alaska Natives (AI/ANs). More AI/ANs are seen in general medical clinics than mental health settings where depression is often undetected by primary care providers. Only modest rates of follow-up, like antidepressant dispensation and mental health referrals occur upon detection. Treatment guidelines have been developed to improve depression detection and treatment, but provider adherence is largely unexamined. March 2001, the Southcentral Foundation, Inc. (an Alaska Native health care organization) implemented a comprehensive depression screening initiative entitled the "Depression Collaborative." The initiative mandates screening of all adult outpatients seen by primary care providers at the organization's Family Medicine clinic on the Alaska Native Medical Center campus. The initiative is considered an administrative success with a 60% completion rate, but concern remains about the needs of the 40% of patients not screened. This clinic also has implemented diagnostic and treatment guidelines that vary by severity of depression. Here, too, provider adherence remains unknown. Given the important questions surrounding this timely initiative, the specific aims of Research Project 3 are to: 1) describe patient and provider characteristics associated with missed depression screening in AI/ANs in primary care. 2) describe the demographic and clinical characteristics of AI/ANs who screen positive for depression. 3) identify how often providers note or diagnose depression when AI/ANs score positive on a screening instrument, as well as variables associated with notation and diagnosis, and 4) assess how often providers follow treatment protocols and factors which affect adherence. The research plan addresses these aims in two separate, but related phases. The first phase focuses on the detection process, which encompasses Aims 1 and 2. The second phase focuses on the management process, which encompasses Aims 3 and 4. This effort will be the first study with a sufficient sample size to provide insight into the differential distribution of depressive symptoms by age, gender, and clinical characteristics in a primary care setting. It also will be the first to examine the effectiveness of depression screening and treatment guidelines with an AI/AN population.