Consortium PSYCHIATRICUMConsortium PSYCHIATRICUMConsortium PSYCHIATRICUM2712-76722713-2919Eco-Vector11210.17816/CP112EDITORIALРЕДАКЦИОННАЯ СТАТЬЯResearch ArticleDiagnosing and Treating Depression and Anxiety in Patients with Cardiovascular Disorders and Diabetes Mellitus in Primary Healthcare: Is Training of Physicians Enough for Improvement?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?https://orcid.org/0000-0002-0958-059656654984500KarpenkoOlga A.КарпенкоОльга Анатольевна
Russian Federation

MD, PhD, The head of scientific collaborations department, Mental Health Clinic No. 1 named after N.A. Alexeev of the Moscow Healthcare Department

drkarpenko@gmail.comhttps://orcid.org/0000-0001-9442-7707MelikhovOleg G.МелиховОлег Геннадьевич
Russian Federation

The head of Scientific Society “The League of Clinical Research”, Director, Institute of Clinical Research, Director, Center of Scientific Methodology, N.A. Semashko National Research Institute of Public Health

melikhov.oleg@gmail.comhttps://orcid.org/0000-0002-2191-062357200694228TyazhelnikovAndrej A.ТяжельниковАндрей Александрович
Russian Federation

MD, PhD, Director of Consultative Diagnostic Polyclinic №121 of Moscow Healthcare Department, chief expert in primary care of Moscow Healthcare Department

tyazhelnikov.kdp121@gmail.comhttps://orcid.org/0000-0002-3073-630557200081884KostyukGeorgiy P.КостюкГеоргий Петрович
Russian Federation

Professor of Psychiatry, Director of Mental Health Clinic No. 1 named after N.A. Alexeev of Moscow Healthcare Department, chief expert in psychiatry of Moscow Healthcare Department

editorinchief@consortium-psy.comMental Health Clinic No.1 named after N.A. AlexeevГБУЗ «ПКБ № 1 им. Н.А. Алексеева ДЗМ»League of Clinical Research, Institute of Clinical ResearchЛига содействия клиническим исследованиямClinical Research InstituteИнститут клинических исследованийScientific and Methodological Center of the National Research Institute of Public Health named after N. A. SemashkoНаучно-методический центр Национального исследовательского института общественного здоровья им. Н.А. СемашкоConsultative Diagnostic Polyclinic №121 of Moscow Healthcare DepartmentГБУЗ «КДП № 121 ДЗМ»2112202131122021242122710202112122021Copyright ©; 2021, Karpenko O.A., Melikhov O.G., Tyazhelnikov A.A., Kostyuk G.P.Copyright ©; 2021, Карпенко О.А., Мелихов О.Г., Тяжельников А.А., Костюк Г.П.2021Karpenko O.A., Melikhov O.G., Tyazhelnikov A.A., Kostyuk G.P.Карпенко О.А., Мелихов О.Г., Тяжельников А.А., Костюк Г.П.https://creativecommons.org/licenses/by/4.0https://consortium-psy.com/jour/article/view/112

INTRODUCTION: Common mental disorders — anxiety and depression — are prevalent among patients with cardiovascular disease (CVD) and diabetes mellitus type 2 (DM) and can negatively influence treatment outcomes and healthcare expenses. Despite the importance of management of depression and anxiety in primary care facilities, the diagnostics and treatment of these disorders remain insufficient in the Russian Federation.

AIM: To explore whether the rates of referrals to psychiatrists and indicated pharmacological treatment received due to depression or anxiety among patients with CVD and DM will significantly change in primary healthcare facilities after the training of primary care physicians (PCPhs) to deal with comorbid depression and anxiety (including the algorithm for referral to a psychiatrist).

METHODS: Patients in primary care outpatient settings with diagnoses of CVD and DM passed screening on anxiety and depression using the Hospital Anxiety and Depression Scale (HADS), and information about the indicated treatment for anxiety or depression was collected when present (Sample 1: n=400). The educational programme for PCPhs on the diagnostics of anxiety and depression was then performed, and PCPhs were instructed to refer patients with HADS >7 to a psychiatrist. After the training, the second sample was collected (Sample 2: n=178) using the same assessments as for Sample 1. The independent expert (psychiatrist) evaluated whether the patients had received the indicated pharmacological treatment according to the screening criteria used in the study for anxiety and depression for both samples.

RESULTS: The proportions of patients with borderline abnormal and abnormal HADS scores (>7) were 365 (91.2%) and 164 (92.1%) in Sample 1 and Sample 2, respectively. In Sample 1, among patients with HADS >7, 119 (29.8%) received psychopharmacological treatment, but in only 46 (38.7%) cases was it indicated in compliance with the screening criteria. In Sample 2, among patients with HADS >7, 59 (33.1%) received psychopharmacological treatment, and in only 14 (23.7%) cases was it indicated in compliance with the screening criteria. The differences in the indicated pharmacological treatment were not statistically significant, and no one from Sample 2 with HADS >7 met a psychiatrist through PCPh referral.

CONCLUSIONS: Anxiety and depression are prevalent in patients with CVD and DM treated in primary care facilities, but these patients may not be receiving the indicated pharmacological treatment. Barriers to referral and the use of psychiatric consultation exist despite the focused training of PCPhs and the straightforward referral protocol provided.

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.

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