Detecting and Managing depression in primary care (SA)

抑郁症在美国印第安人和阿拉斯加原住民（AI/ANs）中很常见。在普通医疗诊所看到的人工智能/人工智能比在精神卫生机构看到的要多，在精神卫生机构中，初级保健提供者往往无法发现抑郁症。只有适度的随访率，如抗抑郁药的分配和心理健康转介发生在检测后。已经制定了治疗指南，以改善抑郁症的检测和治疗，但提供者的依从性在很大程度上未经检查。2001年3月，中南基金会公司（阿拉斯加土著卫生保健组织）实施了一项名为“抑郁症合作”的全面抑郁症筛查倡议。该倡议要求对阿拉斯加土著医疗中心校园内该组织家庭医学诊所的初级保健提供者所见的所有成年门诊病人进行筛查。该倡议被认为是行政上的成功，完成率为60%，但人们仍然担心40%未接受筛查的患者的需求。该诊所还根据抑郁症的严重程度实施了不同的诊断和治疗指南。在这方面，医疗服务提供者的依从性也是未知的。鉴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：

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.