实践启动的抑郁症质量改善的成本效益:随机对照试验的结果
M Schoenbaum1, J Unützer, C Sherbourne
1RAND, 1200 S Hayes St, Arlington, VA 22202, USA. mikels@rand.org
JAMA
|September 19, 2001
概括
在初级保健中改善抑郁症的质量干预措施显示了与公认的医疗治疗相比的社会成本效益. 这些干预措施也改善了患者就业结果.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 临床心理学 临床心理学
- 公共卫生 公共卫生
背景情况:
- 抑郁症是全球残疾的重要原因之一.
- 在初级保健机构的低治疗率有助于增加残疾负担.
- 需要有效的干预措施来改善初级环境中的抑郁症护理.
研究的目的:
- 评估两种质量改善 (QI) 干预措施在初级保健中治疗抑郁症的社会成本效益.
- 评估这些QI干预措施对患者就业状况的影响.
主要方法:
- 一个小组级随机对照试验在46家初级保健诊所进行.
- 包括1356名患有抑郁查结果阳性的患者.
- 两种QI干预 (QI-meds和QI-therapy) 与24个月的常规护理进行了比较.
主要成果:
- 两种QI干预都表现出与既定医疗治疗相比的成本效益,每次获得QALY的成本都处于可接受的范围内.
- 接受QI治疗的患者经历的抑郁负担日数显著减少,工作日数更多.
- 智商医生也显示了减少抑郁症负担和增加就业日的趋势.
结论:
- 实践倡导的抑郁症质量改善努力在社会上具有成本效益.
- 这些干预措施可以对患者就业产生积极影响,为雇主和其他利益相关者带来好处.
- 智商干预是改善初级保健中抑郁症管理的可行策略.
相关概念视频
Long-term Depression
27.3K
Long-term depression, or LTD, is one of the ways by which synaptic plasticity—changes in the strength of chemical synapses—can occur in the brain. LTD is the process of synaptic weakening that occurs over time between pre and postsynaptic neuronal connections. The synaptic weakening of LTD works in opposition to synaptic strengthening by long-term potentiation (LTP) and together are the main mechanisms that underlie learning and memory.
27.3K
The Placebo Effect
5.9K
The placebo effect occurs when people's expectations or beliefs influence or determine their experience in a given situation. In other words, simply expecting something to happen can actually make it happen.
5.9K
Blind Procedures
10.8K
Ideally, the people who observe and record the children’s behavior are unaware of who was assigned to the experimental or control group, in order to control for experimenter bias. Experimenter bias refers to the possibility that a researcher’s expectations might skew the results of the study. Remember, conducting an experiment requires a lot of planning, and the people involved in the research project have a vested interest in supporting their hypotheses. If the observers knew which...
10.8K
Depression: Overview
1.2K
Depression is a prevalent mental illness marked by persistent sadness and lack of interest in previously enjoyable activities. It can take several forms, including major depression, persistent depressive disorder, and bipolar I and II disorders. Symptoms range from emotional changes like chronic worry to physical changes like sleep disturbances and suicidal thoughts. From a neurobiological perspective, depression is believed to be triggered by abnormalities in the brain's prefrontal cortex,...
1.2K
Antidepressant Drugs: MAOIs and Other Agents
1.3K
Atypical antidepressants, including bupropion (Wellbutrin), mirtazapine (Remeron), nefazodone (Serzone), trazodone (Desyrel), and vilazodone (Viibryd), offer unique mechanisms of action. Bupropion weakly inhibits dopamine and norepinephrine reuptake, aiding depression treatment and smoking cessation, with a low risk of sexual dysfunction. Mirtazapine enhances serotonin and norepinephrine neurotransmission, leading to sedation, increased appetite, and weight gain. As a result, it helps treat...
1.3K
Electroconvulsive Therapy
2.6K
Electroconvulsive therapy (ECT), or shock therapy, remains a critical biomedical intervention for severe, treatment-resistant depression. While its origins can be traced back to Hippocrates' observations that malaria-induced convulsions alleviated mental illness, modern ECT has evolved significantly from its earlier, more primitive applications. First introduced in 1938 by Ugo Cerletti and his colleagues, ECT involves inducing controlled seizures using electrical currents. In its early...
2.6K


