背景：阿拉斯加的一个部落卫生组织实施了初级保健抑郁症筛查，在55,000名阿拉斯加原住民/美洲印第安人（AN/AI）中进行检测和管理。
目的：(a)描述患有抑郁症的AN/AIs筛查阳性患者中发现或诊断为抑郁症的比例，以及指南一致管理的比例，(b)评估管理是否因患者和提供者因素而异。
方法：对400个AN/AI的电子和纸质病历信息进行二次分析。
方法：提供程序变量，对患者的人口统计学特征和患者的临床因素进行了电子查询.手动图表审计评估抑郁符号，阳性筛查12周内的诊断和管理。多级序数逻辑模型通过患者和提供者因素评估管理。
结果：在141个（35%）的图表中，有151个（38%）有抑郁症状。在患有中度和重度抑郁症的AN/AI中，检测结果更高（p<0.001）。总的来说,258例患者（66%）接受指南一致管理，32（8%）有一些管理，110人（28%）没有得到管理。年轻的患者年龄和增加的提供者任期增加了管理的几率。
结论：大多数抑郁症筛查阳性的AN/AIs接受了最初的指南一致管理。似乎有必要向老年患者提供更多的外展服务，并为较新的实践提供更多支持。
BACKGROUND: A tribal health organization in Alaska implemented a primary care depression screening, detection and management initiative amongst 55,000 Alaska Native/American Indian people (AN/AIs).
OBJECTIVE: (a) To describe the proportion of AN/AIs screening positive for depression with depression noted or diagnosed and proportion with
guideline concordant management and (b) to assess whether management varied by patient and provider factors.
METHODS: Secondary analysis of electronic and paper medical record information of 400 AN/AIs.
METHODS: Provider variables, patient demographics and patient clinical factors were electronically queried. Manual chart audits assessed depression notation, diagnoses and management within 12 weeks of positive screening. Multilevel ordinal logistic modelling assessed management by patient and provider factors.
RESULTS: A depression diagnosis was present in 141 (35%) charts and 151 (38%) had depressive symptoms noted. Detection was higher among AN/AIs with moderate and severe depression (p<0.001). In total, 258 patients (66%) received
guideline concordant management, 32 (8%) had some management, and 110 (28%) received no management. Younger patient age and increased provider tenure increased odds of management.
CONCLUSIONS: Most AN/AIs screening positive for depression received initial
guideline concordant management. Additional outreach to older patients and additional support for providers newer to practices appears warranted.
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