Objective To evaluate the implementation of a care manager organisation for common mental disorders and its association with antidepressant medication patterns on primary care centre (PCC) level, compared with PCCs without this organisation. Moreover, to determine whether a care manager organisation is associated with antidepressant medication patterns that is more in accordance with treatment guidelines. Design Register-based study on PCC level. Setting Primary care in Region Västra Götaland, Sweden. Participants All PCCs in the region. PCCs were analysed in three subgroups: PCCs with a care manager organisation during 2015 and 2016 (n=68), PCCs without the organisation (n=92) and PCCs that shifted to a care manager organisation during 2016 (n=42). Outcome measures Proportion of inadequate medication users, defined as number of patients >18 years with a common mental disorder diagnosis receiving care at a PCC in the region during the study period and dispensed 1–179 defined daily doses (DDD) of antidepressants of total patients with at least 1 DDD. The outcome was analysed through generalised linear regression and a linear mixed-effects model. Results Overall, all PCCs had about 30%–34% of inadequate medication users. PCCs with a care manager organisation had significantly lower proportion of inadequate medication users in 2016 compared with PCCs without (−6.4%, p=0.02). These differences were explained by higher proportions in privately run PCCs. PCCs that shifted to a care manager organisation had a significant decrease in inadequate medication users over time (p=0.01). Conclusions Public PCCs had a more consistent antidepressant medication pattern compared with private PCCs that gained more by introducing a care manager organisation. It was possible to document a significant decrease in inadequate medication users, notwithstanding that PCCs in the region followed the guidelines to a comparatively high extent regardless of present care manager organisation.

中文翻译：

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护理经理组织的实施及其与抗抑郁药物治疗模式的关联：基于注册的瑞典基层医疗中心研究

目的与没有该组织的PCC相比，评估一个针对普通精神障碍的护理管理者组织的实施情况，并将其与初级保健中心（PCC）级别的抗抑郁药物治疗模式相关联。此外，确定护理经理组织是否与抗抑郁药物治疗模式相关联，而这种抗抑郁药物治疗模式更符合治疗指南。基于PCC级别的基于设计注册的研究。在瑞典VästraGötaland地区设置初级保健。参与者该地区的所有PCC。对PCC进行了三个子组的分析：2015年和2016年具有护理经理组织的PCC（n = 68），没有该组织的PCC（n = 92）和2016年转移到护理经理组织的PCC（n = 42）。成果衡量指标用药不足的比例，定义为患者人数> 在研究期间，在该地区的PCC接受了18年的常见精神障碍诊断，接受了治疗，并向所有至少1 DDD的患者分配了1–179定义的每日抗抑郁药剂量（DDD）。通过广义线性回归和线性混合效应模型对结果进行了分析。结果总体而言，所有PCC约有30％–34％的用药不足者。与没有护理中心的PCC相比，拥有护理经理组织的PCC在2016年的用药不足比例显着降低（−6.4％，p = 0.02）。这些差异是由私营PCC所占比例较高所解释的。随着时间的推移，移交给护理经理组织的PCC的用药不足患者人数显着减少（p = 0.01）。结论与私人PCC相比，公共PCC的抗抑郁药物治疗模式更为一致，后者通过引入护理经理组织获得了更多收益。尽管该地区的PCC相对较高地遵循了指南，但无论当前的护理经理机构如何，都有可能证明使用药物不足的人数显着减少。