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Consortium Psychiatricum
2021. Том 2. № 4. С. 2–12
doi:10.17816/CP112
ISSN: 2712-7672 / 2713-2919 (online)

Диагностика и лечение депрессивных и тревожных расстройств у пациентов с сердечно-сосудистыми заболеваниями и сахарным диабетом в условиях первичной медицинской сети: улучшит ли ситуацию обучение врачей?

1

Карпенко О.А., Мелихов О.Г., Тяжельников А.А., Костюк Г.П.

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Аннотация

ВВЕДЕНИЕ: Тревога и депрессия, являясь распространенными психическими расстройствами, широко представлены среди пациентов с сердечно-сосудистыми заболеваниями (ССЗ) и сахарным диабетом 2 типа (СД), они негативно влияют на результаты лечения и приводят к повышенным затратам со стороны системы здравоохранения. Несмотря на важность диагностики и лечения тревожных и депрессивных расстройств на уровне первичного звена медицинской помощи, в Российской Федерации эта проблема до сих пор не решена.

ЦЕЛЬ: Исследовать, изменится ли количество направлений к психиатру и число случаев корректного лечения депрессивных и тревожных расстройств у пациентов первичной медицинской сети с ССЗ и СД после обучения врачей поликлиник ведению пациентов с коморбидными депрессивными и тревожными расстройствами (включая алгоритм направления к психиатру).

МЕТОДЫ: На первом этапе исследования пациентам с ССЗ и СД, проходящим лечение в поликлинике, проводили скрининг на выявление тревоги и депрессии при помощи Госпитальной Шкалы Тревоги и Депрессии (HADS). Если пациент принимал психофармакотерапию, название лекарства и его доза заносились в карту исследования. Всего было обследовано 400 человек. На втором этапе врачи поликлиники проходили образовательную программу по диагностике тревожно-депрессивных расстройств, в рамках которой они были проинструктированы, что все пациенты с баллами по шкале HADS >7 должны направляться к психиатру. После обучения на третьем этапе исследования была набрана вторая выборка пациентов (n=178) с использованием такого же протокола, как и на первом этапе. Независимым экспертом (психиатром) оценивалась адекватность психофармакотерапии у пациентов обеих выборок по результатам скрининга тревоги и депрессии в соответствии с критериями, разработанными для данного исследования.

РЕЗУЛЬТАТЫ: Доля пациентов с уровнем тревоги и/или депрессии выше нормального по шкале HADS (>7) составляла 365 (91,2%) в первой выборке и 164 (92,1%) во второй выборке. В первой выборке среди пациентов с HADS >7 119 (29,8%) человек получали психофармакотерапию, но только у 46 (38,7%) она соответствовала результатам скрининга. Во второй выборке среди пациентов HADS >7 59 (33,1%) человек получали психофармакотерапию, но только у 14 (23,7%) она соответствовала результатам скрининга. Разница между выборками по этим показателям не достигала статистической значимости, ни один пациент из второй выборки не был направлен к психиатру.

ЗАКЛЮЧЕНИЕ: Тревога и депрессия часто встречаются у пациентов с ССЗ и СД, обращающихся за лечением в поликлинику, но при этом пациенты не получают адекватную психофармакотерапию. Несмотря на проведение целенаправленного обучения и предоставления врачам поликлиник протокола направления пациентов к психиатру, существуют барьеры осуществления таких направлений и получения пациентами консультаций психиатра.

Общая информация

Ключевые слова: депрессия, тревога, первичная помощь, психическое здоровье

Рубрика издания: Редакционные статьи

Тип материала: научная статья

DOI: https://doi.org/10.17816/CP112

Получена: 27.10.2021

Принята в печать:

Для цитаты: Карпенко О.А., Мелихов О.Г., Тяжельников А.А., Костюк Г.П. Диагностика и лечение депрессивных и тревожных расстройств у пациентов с сердечно-сосудистыми заболеваниями и сахарным диабетом в условиях первичной медицинской сети: улучшит ли ситуацию обучение врачей? // Consortium Psychiatricum. 2021. Том 2. № 4. С. 2–12. DOI: 10.17816/CP112

Литература

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Информация об авторах

Карпенко Ольга Анатольевна, MD, PhD, ГБУЗ «Психиатрическая клиническая больница № 1 им. Н.А. Алексеева Департамента здравоохранения города Москвы», Москва, Россия, ORCID: https://orcid.org/0000-0002-0958-0596, e-mail: drkarpenko@gmail.com

Мелихов Олег Геннадиевич, кандидат медицинских наук, Руководитель Центра организации и планирования научных исследований в здравоохранении, ФГБНУ «Национальный НИИ общественного здоровья имени Н.А. Семашко», Директор Института клинических исследований; Председатель совета научного общества «Лига содействия клиническим исследованиям», Москва, Россия, ORCID: https://orcid.org/0000-0001-9442-7707

Тяжельников Андрей Александрович, доктор медицинских наук, главный внештатный специалист по первичной медико-санитарной помощи взрослому населению, Департамент здравоохранения Москвы, главный врач ГБУЗ «Консультативно-диагностическая поликлиника №121», Москва, Россия, ORCID: https://orcid.org/0000-0002-2191-0623

Костюк Георгий Петрович, доктор медицинских наук, профессор, врач-психиатр высшей квалификационной категории, Главный врач, ГБУЗ «Психиатрическая клиническая больница № 1 им. Н.А. Алексеева Департамента здравоохранения города Москвы», главный внештатный специалист-психиатр Департамента здравоохранения города Москвы, полковник медицинской службы запаса., Москва, Россия, ORCID: https://orcid.org/0000-0002-3073-6305, e-mail: editorinchief@consortium-psy.com

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