利用COVID-19来现代化VA初级保健群体的抑郁症护理:顺序解释混合方法评估协议
Lucinda B Leung1,2,3, Catherine E Brayton4, Robyn L Shepardson3,5
1Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA lleung@mednet.ucla.edu.
BMJ open
|December 16, 2025
概括
COVID-19大流行影响了VA的抑郁症护理质量,可能会影响患者的治疗结果. 本研究研究了护理轨迹,虚拟护理扩张和死亡率,以指导未来抑郁症查和治疗的干预措施.
科学领域:
- 医疗保健服务研究 医疗服务研究
- 心理健康服务 心理健康服务
- 流行病学 流行病学
背景情况:
- 退伍军人健康管理局 (VA) 整合了精神和身体健康服务,以检测和治疗抑郁症.
- 初级护理护士每年都会进行抑郁症查,并由初级护理心理健康整合 (PCMHI) 专家等临床医生进行随访.
- 随着COVID-19大流行和远程医疗的扩张,复杂的多利益相关者抑郁症护理过程发生了重大破坏.
研究的目的:
- 检查COVID-19大流行是否恶化了抑郁症护理质量和患者结果,包括自杀风险.
- 评估与流行病相关的干扰和远程医疗扩张对抑郁症护理的影响.
- 识别抑郁症检测中的差异,并指导未来的干预措施.
主要方法:
- 评估了VA人口从积极抑郁症查到治疗的轨迹 (2019-2023财年),分析了虚拟与亲身护理组合.
- 使用中断时间序列分析来评估抑郁症检测是否会减轻精神病医院急诊/住院治疗,并比较死亡率.
- 在三个VA设施中与退伍军人和提供者进行了定性采访,以了解大流行影响和混合护理模式的最佳实践.
主要成果:
- 在疫情期间分析抑郁症护理轨迹和虚拟护理利用情况.
- 间断时间序列分析了精神病医院急诊,住院和与心理健康有关的死亡率.
- 关于退伍军人和提供者与混合护理模式和流行病引起的变化经验的定性研究结果.
结论:
- 该研究将提供关于大流行对抑郁症护理质量和VA患者治疗结果的影响的见解.
- 结果将确定特定的领域和患者群体 (例如,少数群体,低PCMHI接入的人) 抑郁症检测次优.
- 将确定混合面对面/远程医疗抑郁症护理模式的最佳实践,以改善患者-提供者互动和整体护理质量.
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