老年人开具抗抑郁药处方后的关系连续性与家庭医生随访之间的关系:一项回顾性队列研究

IF 4.3 3区 材料科学 Q1 ENGINEERING, ELECTRICAL & ELECTRONIC
David Rudoler, Natasha Lane, Agnes Grudniewicz, Vicki Ling, David Snadden, Therese A Stukel
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引用次数: 0

摘要

副作用可能在开始服用抗抑郁药物的数小时至数天内出现,而对情绪的全面治疗通常需要长达四周的时间。这种危害发生时间与获益滞后之间的不匹配往往会导致过早停用抗抑郁药物,而这种现象可以通过早期医患沟通和随访得到部分扭转。我们调查了护理关系的连续性--家庭医生护理老年患者的年数--与处方抗抑郁药患者的早期随访护理之间的关系。我们对加拿大安大略省 66 岁或以上的居民进行了一项回顾性队列研究,这些居民在 2016 年 4 月 1 日至 2019 年 3 月 31 日期间通过省级药物保险计划首次获得抗抑郁药处方。该研究利用多变量回归估算了关系连续性与处方家庭医生 30 天随访之间的关系。分别对居住在城市、非大城市和农村社区的老年人进行了估算。研究发现,对于首次获得抗抑郁药处方的患者,护理关系的连续性与处方家庭医生的随访护理之间存在微小的正相关关系(RRR = 1.005; 95% CI = 1.004, 1.006)。这种关系受患者居住地的影响,居住在非大城市(RRR = 1.009; 95% CI = 1.007, 1.012)和农村社区(RRR = 1.006; 95% CI = 1.002, 1.011)的老年人受到的影响更大。我们的研究结果并没有提供强有力的证据来证明连续性护理关系与更高质量的抗抑郁药处方管理之间的关系。然而,在农村社区,这种关系略微明显,因为在农村社区,获得连续性初级医疗保健和专业心理健康服务的途径更为有限。这可能支持了在农村社区招聘和留住初级医疗服务提供者的持续需求。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
The relationship between relational continuity and family physician follow-up after an antidepressant prescription in older adults: a retrospective cohort study
Side effects can occur within hours to days of starting antidepressant medications, whereas full therapeutic benefit for mood typically takes up to four weeks. This mismatch between time to harm and lag to benefit often leads to premature discontinuation of antidepressants, a phenomenon that can be partially reversed through early doctor-patient communication and follow-up. We investigated the relationship between relational continuity of care – the number of years family physicians have cared for older adult patients – and early follow-up care for patients prescribed antidepressants. A retrospective cohort study was conducted on residents of Ontario, Canada aged 66 years or older who were dispensed their first antidepressant prescription through the provincial drug insurance program between April 1, 2016, and March 31, 2019. The study utilized multivariable regression to estimate the relationship between relational continuity and 30-day follow-up with the prescribing family physician. Separate estimates were generated for older adults living in urban, non-major urban, and rural communities. The study found a small positive relationship between relational continuity of care and follow-up care by the prescribing family physician for patients dispensed a first antidepressant prescription (RRR = 1.005; 95% CI = 1.004, 1.006). The relationship was moderated by the patients’ location of dwelling, where the effect was stronger for older adults residing in non-major urban (RRR = 1.009; 95% CI = 1.007, 1.012) and rural communities (RRR = 1.006; 95% CI = 1.002, 1.011). Our findings do not provide strong evidence of a relationship between relational continuity of care and higher quality management of antidepressant prescriptions. However, the relationship is slightly more pronounced in rural communities where access to continuous primary care and specialized mental health services is more limited. This may support the ongoing need for the recruitment and retention of primary care providers in rural communities.
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CiteScore
7.20
自引率
4.30%
发文量
567
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