Protocol of an ongoing randomized controlled trial of care management for comorbid depression and hypertension: the Chinese Older Adult Collaborations in Health (COACH) study.
Protocol of an ongoing randomized controlled trial of care management for comorbid depression and hypertension: the Chinese Older Adult Collaborations in Health (COACH) study.
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DOI：
10.1186/s12877-018-0808-1
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发表时间：
2018-05-29
期刊：
影响因子：
4.1
通讯作者：
Dong H
中科院分区：
文献类型：
--
作者：
Chen S;Conwell Y;Xue J;Li LW;Tang W;Bogner HR;Dong H
抑郁症和高血压是中国迅速老龄化的人口中常见的、昂贵的和破坏性的疾病。这两种疾病通常并存，认识不足，治疗不足，特别是在农村地区。中国老年人健康协作（COACH）研究是一项随机对照试验（RCT），旨在检验以下假设：COACH干预（旨在管理中国农村老年初级保健患者的抑郁和高血压共病）将导致更好的治疗依从性，抑郁症状和血压控制的更大改善以及更好的生活质量，比增强型护理（eCAU）更好。根据慢性病管理和协作护理原则，COACH模式将老年人初级保健提供者提供的护理与该村老龄协会老龄工作者提供的护理相结合，并由精神病顾问监督。将从浙江省两个县随机选择160个村庄，每个村庄由一名PCP提供服务，并被分配提供eCAU或COACH干预。本研究将招募来自选定村庄的约2400名患有临床显著抑郁症状和高血压诊断的老年居民，并按他们居住和接受初级保健的那些村庄进行随机分配。在给予知情同意后，他们将接受基线研究评估;接受12个月的治疗，采用他们所在村庄分配的方法;并在进入后3、6、9和12个月进行重新评估。抑郁和HTN控制是主要结局。将从受试者的电子病历（EMR）中获得接受的治疗、医疗保健利用和成本数据，并用于评估对护理建议的依从性，并初步确定干预的成本和成本效益。COACH干预措施旨在作为一种模式，用于以初级保健为基础的管理常见的精神障碍，这些精神障碍与常见的慢性疾病一起发生。它利用农村环境中的现有资源，将社会干预与医疗模式相结合，并与农村生活的文化背景相一致。ClinicalTrials.gov ID：NCT 01938963;首次发布：2013年9月10日。
Depression and hypertension are common, costly, and destructive conditions among the rapidly aging population of China. The two disorders commonly coexist and are poorly recognized and inadequately treated, especially in rural areas. The Chinese Older Adult Collaborations in Health (COACH) Study is a cluster randomized controlled trial (RCT) designed to test the hypotheses that the COACH intervention, designed to manage comorbid depression and hypertension in older adult, rural Chinese primary care patients, will result in better treatment adherence and greater improvement in depressive symptoms and blood pressure control, and better quality of life, than enhanced Care-as-Usual (eCAU). Based on chronic disease management and collaborative care principles, the COACH model integrates the care provided by the older person’s primary care provider (PCP) with that delivered by an Aging Worker (AW) from the village’s Aging Association, supervised by a psychiatrist consultant. One hundred sixty villages, each of which is served by one PCP, will be randomly selected from two counties in Zhejiang Province and assigned to deliver eCAU or the COACH intervention. Approximately 2400 older adult residents from the selected villages who have both clinically significant depressive symptoms and a diagnosis of hypertension will be recruited into the study, randomized by the villages in which they live and receive primary care. After giving informed consent, they will undergo a baseline research evaluation; receive treatment for 12 months with the approach to which their village was assigned; and be re-evaluated at 3, 6, 9, and 12 months after entry. Depression and HTN control are the primary outcomes. Treatment received, health care utilization, and cost data will be obtained from the subjects’ electronic medical records (EMR) and used to assess adherence to care recommendations and, in a preliminary manner, to establish cost and cost effectiveness of the intervention. The COACH intervention is designed to serve as a model for primary care-based management of common mental disorders that occur in tandem with common chronic conditions of later life. It leverages existing resources in rural settings, integrates social interventions with the medical model, and is consistent with the cultural context of rural life. ClinicalTrials.gov ID: NCT01938963; First posted: September 10, 2013.
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