Tính hiệu quả về chi phí của chăm sóc phối hợp cho bệnh nhân mắc các bệnh mãn tính có rối loạn trầm cảm phối hợp trong bối cảnh bệnh viện tổng quát, một thử nghiệm kiểm soát ngẫu nhiên
Tóm tắt
Rối loạn trầm cảm là một trong những rối loạn phổ biến nhất và có tỷ lệ cao ở những bệnh nhân mắc bệnh mãn tính. Sự hiện diện của trầm cảm kèm theo có ảnh hưởng tiêu cực đến chất lượng cuộc sống, chi phí chăm sóc sức khỏe, khả năng tự chăm sóc, tỷ lệ mắc bệnh và tỷ lệ tử vong. Chẩn đoán sớm và điều trị trầm cảm được tổ chức tốt có ảnh hưởng tích cực đến những khía cạnh này. Nghiên cứu trước đây ở Hoa Kỳ đã báo cáo kết quả tốt liên quan đến việc điều trị trầm cảm với phương pháp chăm sóc hợp tác và một thuật toán thuốc chống trầm cảm. Tại Vương quốc Anh, 'Điều trị Giải quyết Vấn đề' đã chứng minh là khả thi. Tuy nhiên, trong bối cảnh bệnh viện tổng quát, phương pháp này vẫn chưa được đánh giá.
CC: DIM (Chăm sóc phối hợp: Sáng kiến trầm cảm trong môi trường y tế) là một thử nghiệm kiểm soát ngẫu nhiên hai nhánh với randomisation ở cấp độ bệnh nhân. Mục tiêu của thử nghiệm là đánh giá điều trị rối loạn trầm cảm ở các bệnh viện tổng quát tại Hà Lan dựa trên khuôn khổ chăm sóc phối hợp, bao gồm hợp đồng, 'Điều trị Giải quyết Vấn đề', thuật toán thuốc chống trầm cảm và hướng dẫn tự hỗ trợ. 126 bệnh nhân ngoại trú mắc tiểu đường, bệnh phổi tắc nghẽn mạn tính hoặc bệnh tim mạch sẽ được phân ngẫu nhiên vào nhóm can thiệp hoặc nhóm đối chứng. Bệnh nhân sẽ được đưa vào nếu họ được chẩn đoán mắc trầm cảm mức độ vừa đến nặng, dựa trên tiêu chí DSM-IV theo phương pháp sàng lọc hai bước. Nhóm can thiệp sẽ nhận điều trị dựa trên phương pháp chăm sóc phối hợp; nhóm đối chứng sẽ nhận 'chăm sóc như thường lệ'. Các phép đo cơ bản và theo dõi (sau 3, 6, 9, và 12 tháng) sẽ được thực hiện thông qua bảng hỏi. Thước đo kết quả chính là mức độ nghiêm trọng của triệu chứng trầm cảm, được đo bằng PHQ-9. Thước đo kết quả thứ hai là tính hiệu quả về chi phí của các phương pháp điều trị này theo TiC-P, EuroQol và SF-36.
Nghiên cứu trước đây đã chỉ ra rằng rối loạn trầm cảm là một bệnh mãn tính, chủ yếu tái phát, có xu hướng kết hợp với bệnh lý thể chất kèm theo. Mặc dù việc điều trị rối loạn trầm cảm dựa trên hướng dẫn cho trầm cảm đã chứng minh là hiệu quả, nhưng các hướng dẫn này thường không được tuân thủ đầy đủ. Chăm sóc phối hợp và 'Điều trị Giải quyết Vấn đề' sẽ được điều chỉnh riêng cho bệnh nhân mắc rối loạn trầm cảm và được đánh giá trong bối cảnh bệnh viện tổng quát tại Hà Lan.
Từ khóa
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