Detecting and Managing depression in primary care

抑郁症在美国印第安人和阿拉斯加原住民（AI/AN）中很常见。更多的AI/AN出现在 一般的医疗诊所比精神卫生机构，在那里抑郁症往往是无法发现的初级保健 提供商只有适度的后续率，如抗抑郁药的分配和心理健康转诊发生 被发现后已经制定了治疗指南来改善抑郁症的检测和治疗， 但供应商的遵守情况在很大程度上没有得到检查。2001年3月，中南基金会，公司。(an阿拉斯加 土著卫生保健组织）实施了一项名为 “抑郁症合作。“该倡议要求对所有接受初级保健的成年门诊病人进行筛查， 该组织在阿拉斯加土著医疗中心校园的家庭医学诊所的供应商。的 该倡议被认为是一项行政成功，完成率为60%，但人们仍然担心， 40%的患者没有接受筛查。该诊所还实施了诊断和治疗 根据抑郁症的严重程度而不同。在这方面，供应商的遵守情况仍然未知。鉴于 围绕这一及时举措的重要问题，研究项目3的具体目标是： 1)描述与AI/AN中错过抑郁筛查相关的患者和提供者特征 在初级保健。 2)描述抑郁症筛查阳性的AI/AN的人口统计学和临床特征。 3)确定当AI/AN在筛查中得分为阳性时，提供者注意到或诊断抑郁症的频率 仪器，以及与符号和诊断相关的变量，以及 4)评估提供者遵循治疗方案的频率以及影响依从性的因素。 研究计划分两个独立但相关的阶段实现这些目标。第一阶段的重点是 检测过程，其中包括目标1和2。第二阶段是管理 这一进程包括目标3和4。 这项工作将是第一项具有足够样本量的研究，以深入了解差异 在初级保健环境中按年龄、性别和临床特征划分的抑郁症状分布。它 也将是第一个检查抑郁症筛查和治疗指南的有效性， AI/AN人群。

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.