PDF(Pubmed)
Abstract：
UNASSIGNED: In the United States, access to evidence-based behavioral health treatment remains limited, contributing to inadequate treatment for individuals with depression and anxiety disorders. The Collaborative care model (CoCM), the integration of behavioral healthcare into primary care, has been shown to be effective in addressing this issue, particularly when delivered virtually through telehealth platforms. While collaborative care has been shown to be effective, little has been studied to understand the impact of patient treatment factors on patient improvement. This study aims to analyze factors associated with patient improvement, measured by PHQ-9 and GAD-7 score changes, in patients with depression and anxiety disorders from Concert Health, a national behavioral medical group offering collaborative care across 18 states.
UNASSIGNED: Stepwise logistic regression models were utilized to identify factors influencing patient improvement in standardized symptom screener scores (PHQ-9 and GAD-7). Relevant patient-level data, including demographics, clinical engagement, insurance type, clinical touchpoints, and other variables, were analyzed. Results are presented as odds ratios (ORs).
UNASSIGNED: We find that increased clinical touchpoints were associated with improved outcomes in both depression (PHQ-9) and anxiety (GAD-7) populations. Commercial insurance was linked to a greater likelihood of improvement relative to Medicaid, and the use of C-SSRS suicide screeners had varied effects on patient outcomes depending on the diagnosis. The duration of time spent in appointments showed a nuanced impact, suggesting an optimal length for touchpoints. Psychiatric consults also impact patient outcomes in both populations. This study sheds light on factors influencing patient outcomes in virtual collaborative care for depression and anxiety disorders, which may be used to inform and motivate further research and allow providers to better optimize and understand the impacts of treatment choices in collaborative care settings.
UNASSIGNED: Stepwise logistic regression models were utilized to identify factors influencing patient improvement in standardized symptom screener scores (PHQ-9 and GAD-7). Relevant patient-level data, including demographics, clinical engagement, insurance type, clinical touchpoints, and other variables, were analyzed. Results are presented as odds ratios (ORs).
UNASSIGNED: We find that increased clinical touchpoints were associated with improved outcomes in both depression (PHQ-9) and anxiety (GAD-7) populations. Commercial insurance was linked to a greater likelihood of improvement relative to Medicaid, and the use of C-SSRS suicide screeners had varied effects on patient outcomes depending on the diagnosis. The duration of time spent in appointments showed a nuanced impact, suggesting an optimal length for touchpoints. Psychiatric consults also impact patient outcomes in both populations. This study sheds light on factors influencing patient outcomes in virtual collaborative care for depression and anxiety disorders, which may be used to inform and motivate further research and allow providers to better optimize and understand the impacts of treatment choices in collaborative care settings.
摘要：
■在美国，获得循证行为健康治疗的机会仍然有限，导致抑郁症和焦虑症患者的治疗不足。协作护理模式(CoCM)，将行为保健纳入初级保健，已经证明在解决这个问题上是有效的，特别是通过远程医疗平台虚拟交付时。虽然协作护理已被证明是有效的，很少有研究了解患者治疗因素对患者改善的影响。本研究旨在分析与患者改善相关的因素，通过PHQ-9和GAD-7评分变化来衡量，来自ConcertHealth的抑郁症和焦虑症患者，一个全国性的行为医学团体，在18个州提供协作护理。
■使用逐步逻辑回归模型来确定影响患者改善的标准化症状筛查评分（PHQ-9和GAD-7）的因素。相关患者级别数据，包括人口统计，临床参与，保险类型,临床接触点，和其他变量，进行了分析。结果以比值比(OR)表示。
■我们发现，在抑郁（PHQ-9）和焦虑（GAD-7）人群中，增加的临床接触点与改善的结果相关。商业保险与医疗补助改善的可能性更大，根据诊断的不同,使用C-SSRS自杀筛查对患者结局有不同的影响.约会的持续时间显示出细微的影响，建议接触点的最佳长度。精神病咨询也会影响这两个人群的患者预后。这项研究揭示了在抑郁和焦虑症的虚拟协作护理中影响患者预后的因素。这可用于为进一步的研究提供信息和激励，并允许提供者更好地优化和理解协作护理环境中治疗选择的影响。
■使用逐步逻辑回归模型来确定影响患者改善的标准化症状筛查评分（PHQ-9和GAD-7）的因素。相关患者级别数据，包括人口统计，临床参与，保险类型,临床接触点，和其他变量，进行了分析。结果以比值比(OR)表示。
■我们发现，在抑郁（PHQ-9）和焦虑（GAD-7）人群中，增加的临床接触点与改善的结果相关。商业保险与医疗补助改善的可能性更大，根据诊断的不同,使用C-SSRS自杀筛查对患者结局有不同的影响.约会的持续时间显示出细微的影响，建议接触点的最佳长度。精神病咨询也会影响这两个人群的患者预后。这项研究揭示了在抑郁和焦虑症的虚拟协作护理中影响患者预后的因素。这可用于为进一步的研究提供信息和激励，并允许提供者更好地优化和理解协作护理环境中治疗选择的影响。
