慢性病病案管理模式对社区老年抑郁症疗效的影响  

Effectiveness of case management of chronic disease for elderly depression in community

作　　者：吴海苏[1] 徐勇[1] 徐一峰[1] 朱惠仙[2] 朱丽萍[1] 薛晶晶[2] 王稼颖 

机构地区：[1]上海交通大学医学院附属精神卫生中心,上海200030 [2]上海市徐家汇社区卫生服务中心,上海200030

出　　处：《中国心理卫生杂志》2010年第4期245-249,共5页Chinese Mental Health Journal

基　　金：上海市预防精神医学重点学科建设子项目(05Ⅲ028-01);卫生部与世界卫生组织卫生技术合作项目(WP/2004/CHN/NCD/2.5/001/01.02.FE.01)

摘　　要：目的:探讨慢性病病案管理模式对我国社区老年抑郁症患者疗效的影响。方法:采用随机对照研究方法,将年龄≥60岁,符合美国《精神障碍诊断与统计手册》(Diagnostic and Statistical Manual of Mental Disorder,Fourthedition,DSM-Ⅳ)抑郁症诊断标准的120例老年抑郁症患者,随机分成干预组(N=60)和对照组(N=60)。干预组实行慢性病病案管理模式,即精神科医生、社区医生和病案管理员共同对老年抑郁症患者实施综合治疗方案,如健康教育、心理治疗和药物治疗等;对照组按照目前社区日常的医学方式进行。在治疗前,治疗第2、4、6、8、12周末分别应用汉密尔顿抑郁量表(Hamilton Depression Scale,HAMD-17)、临床疗效总评量表(ClinicalGlobalImpression,CGI)、治疗副反应量表(Treatment Emergent Symptom Scale,TESS)对两组患者的疗效和药物不良反应进行评定。结果:在治疗12周末,干预组患者HAMD-17总分[(14.19±7.66)vs.(24.93±5.86)]和CGI-GI评分[(1.61±0.92)vs.(3.43±1.42)]均低于对照组(均P<0.01);干预组有效率(83.1%vs.39.3%)、临床治愈率(27.1%vs.5.4%)高于对照组(均P<0.01);干预组患者坚持服药率高于对照组(98.3%vs.35%,P<0.01);两组患者药物不良反应轻微,且差异无统计学意义(P>0.05)。结论:应用慢性病病案管理模式可以有效地减轻抑郁症状,增加抗抑郁药的使用,提高治疗效果。Objective： To explore the effectiveness of case management of chronic disease for elderly depres- sion. Methods： Totally 120 elderly patients meeting the Diagnostic and Statistical Manual of Mental Disorder, Fourth edition, （ DSM-IV ） criteria for major depression were enrolled in the study. All patients were randomly di- vided into intervention group （ N = 60 ） and control group C N = 60 ） . Intervention group patients received collaborative care provided by psychiatrists, primary care doctors and case managers, including health education, psycho- therapy and antidepressants. Control group patients were treated by usual medical model. The period of observation was 12 weeks. Effectiveness and safety were assessed with the Hamilton Depression Scale （ HAMD ）, Clinical Global Impression （CGI） and Treatment Emergent Symptom Scale （TESS） at baseline, at the end of the 2nd, 4th, 6th, 8th, and 12th week after treatment. Results： At the end of the 12th week after treatment, the HAMD-17 scores [ （14.19±7.66） vs. [24.93±5.86）] andCGI-Glscores[ （1.61±0.92） vs. （3.43±1.42）]ininter- vention group were significantly lower than those in control group （Ps 〈 0. 01 } . After 12 weeks, the rates of effectiveness 183. 1% vs. 39.3% ） and remission 127.1% vs. 5.4% ） in intervention group were significantly higher than those in the control group （ Ps 〈 0.01 ） . There was significant difference in the rate of taking antidepressants （98. 3% vs. 35%, P 〈0. 01 ） between intervention group and control group. All adverse effects were mild in both groups and there was no statistical difference （ Ps 〉 0. 05 ） . Conclusion： The case management of chronic disease model appears to be effective to relief depressive symptoms, enhance antidepressants treatment copmlianee and im- prove the outcome.

关 键 词：社会精神病学 老年抑郁症 病案管理 慢性病 综合治疗 随机对照研究 

分 类 号：R749.4[医药卫生—神经病学与精神病学] R197.323[医药卫生—临床医学]