目的：探讨“心境-促进协作医疗”（IMPACT）管理模式对社区老年抑郁症患者生活质量影响及卫生经济学价值。方法对30名社区老年抑郁症患者实施为期2年的IMPACT管理治疗，按1：1配对另30例作为对照组，对其实施常规的社区精神病康复管理。在干预第一年末及第二年末使用汉密尔顿量表（HAMD）、家庭负担表（FIS）、生活满意度（LSR）进行评定并观察费用成本。结果在实施干预的第一年末和第二年末,干预组患者的HAMD和FIS得分较对照组显著降低、干预组患者LSR得分较对照组显著升高（列联表卡方检验结果中，χ2均大于5.9，P值均<0.05）。2年内干预组患者总费用低于对照组，表现在门诊费用、住院费用、社区防治费用和家属误工费用等方面干预者患者的支出要明显少于对照组患者（t检验结果中，P值均<0.05）；同时，两者患者在药物费用支出方面无显著差异。结论 IMPACT管理模式能有效减轻社区老年抑郁症患者的抑郁症状，并显著降低患者因疾病产生的各项费用成本。%Objective To discuss the effectiveness of the IMPACT collaborative care management program on life quality of late-life depression in primary care and preliminary health economy analysis. Methods 30 elderly depressions as the intervention group patients were treated by 2 years’IMPACT collaborative care. Another 30 elderly depressions were chosen as the control group pa-tients by 1:1 matching. They were treated by general care. Effectiveness was assessed by using the Hamilton Depression Scale (HAMD), Family Interview Schedule(FIS), Life Satisfaction Rating Scale (LSR) 1 year and 2 years after intervention; And the costs were observed at the time. Results The HAMD and FIS scores in intervention group were significantly lower than those in control group at the time of 1 year and 2 years after intervention, The LSR score was higher than those in control group (χ2>5.9,P<0.05). The two years’costs were less in the intervention group, especially that on out-patient service, hospitalization, community interven-tion and treatment, and work loss of caregivers (P<0.05), there’s no difference on medical treatment between two groups Conclu-sion The Improving Mood-Promoting Access to Collaborative Treatment (IMPACT) collaborative care management program for late-life depression could relieve the depressive symptoms effectively with less cost.
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