Outreach to Reduce Disparities in Depression Treatment Initiation

开展外展活动，减少抑郁症治疗启动方面的差异

• 批准号: 10197809
• 负责人: Beth E. Waitzfelder
• 金额: $ 11.29万
• 依托单位: KAISER FOUNDATION RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-23 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10197809
• 关键词: Address; Adherence; African American; Aftercare; Antidepressive Agents; Asians; Caring; Clinical; Data; Diagnosis; Disease remission; Drops; Education; Ethnic group; Failure; Health system; Healthcare Systems; Hispanics; Income; Intervention; Intervention Studies; Mental Depression; Mental Health; Native Hawaiian; Not Hispanic or Latino; Outcome; Pacific Island Americans; Patient Care; Patients; Pharmaceutical Preparations; Pilot Projects; Population; Primary Health Care; Provider; Psychotherapy; Race; Randomized; Records; Research; Research Personnel; Technology; Testing; Time; Visit; Work; alternative treatment; arm; care outcomes; care providers; collaborative care; comparison intervention; design; disparity reduction; eHealth; effectiveness testing; ethnic minority population; experience; follow-up; group intervention; improved; improved outcome; outreach; outreach program; pilot trial; pragmatic trial; preference; primary outcome; programs; racial and ethnic disparities; racial minority; response; secondary outcome; telehealth; therapy design; treatment adherence; treatment as usual; usual care arm

Failure to initiate treatment is a major gap in care for depression - A recent Mental Health Research Network (MHRN) study involving more than 240,000 patients in 5 health systems with a new diagnosis of depression in primary care found that only about a third (36%) had completed a psychotherapy visit or filled a prescription for antidepressant medication within 90 days of a new depression diagnosis. Large racial and ethnic disparities in depression treatment initiation exist – In that MHRN study the odds of Asians, Blacks and Hispanics initiating treatment were 30% lower than for Non-Hispanic Whites. Previous research has focused on care after treatment initiation – Collaborative care and care management programs can reduce disparities, improving outcomes among traditionally under-served racial and ethnic groups. This work, however, has usually focused on those who have already initiated treatment. Interventions improve treatment initiation must accommodate diversity of patient experience and preferences –Underserved racial and ethnic groups may prefer psychotherapy over medication and may also prefer alternative treatments or alternative care providers. One size of depression treatment does not fit all. eHealth technologies have the potential to address failures in treatment initiation – Previous research by MHRN investigators and others demonstrates that online messaging and other telehealth technologies can effectively and efficiently improve depression treatment adherence. These interventions, however, have focused on adherence after treatment initiation and have been tested primarily in non-Hispanic white patients. Proposed trial: This pilot study will refine, adapt and test an outreach intervention to improve depression treatment initiation among patients recently receiving a new diagnosis of depression in primary care. Focusing on African American, Asian, Native Hawaiian/Pacific Islander and Hispanic patients, the study will leverage existing MHRN work to implement an automated outreach program with follow-up care facilitation by mental health clinicians. The intervention will utilize analytic and technological expertise developed by the MHRN to rapidly identify patients, send outreach messages, conduct assessments and facilitate care for patients with depression who fail to initiate treatment in a timely manner. The intervention will be developed with the input of patients in the target racial and ethnic minority populations and providers. Approximately 400 eligible patients in two MHRN health systems will be randomized to the intervention group or usual care. Outcomes (treatment initiation and rates recorded depression remission and response) will be ascertained from health system records. Analyses will examine intervention participation and compare the primary outcome (treatment initiation) and secondary outcomes (recorded depression remission and response) between groups. Results will inform a subsequent full-scale pragmatic trial to assess reduction in population-level disparities.

无法开始治疗是抑郁症的主要差距 - 最近的心理健康研究 网络（MHRN）研究涉及5个卫生系统中的240,000多名患者 初级保健的抑郁症发现，只有大约三分之一（36％）完成了心理治疗访问或填补了 在新的抑郁诊断后的90天内，抗抑郁药的处方处方。 抑郁症治疗开始中存在巨大的种族和种族差异 - 该MHRN研究了几率 在亚洲人中，黑人和西班牙裔的待遇比非西班牙裔白人低30％。 先前的研究重点是护理后的治疗计划 - 协作和护理 管理计划可以减少分布，改善传统服务不足的种族的结果 和种族。但是，这项工作通常集中在已经开始治疗的人身上。 干预措施改善治疗计划必须适应患者经验的多样性和 偏好 - 不受欢迎的种族和种族群体可能宁愿心理治疗而不是药物治疗 喜欢替代治疗或替代护理提供者。一种抑郁症治疗的大小并不适合全部。 eHealth技术有可能解决治疗计划的失败 - 先前的研究 MHRN调查人员和其他人表明，在线消息传递和其他远程医疗技术可以 但是，这些干预措施有 专注于治疗计划后的依从性，并主要针对非西班牙裔白人患者进行了测试。 拟议的试验：这项试点研究将完善，适应和测试外展干预以改善抑郁症 最近接受新的初级保健抑郁诊断的患者的治疗计划。专注 关于非裔美国人，亚洲人，本地夏威夷/太平洋岛民和西班牙裔患者，该研究将利用 现有的MHRN工作以通过心理来实施具有后续护理机构的自动外展计划 卫生临床医生。干预将利用MHRN开发的分析和技术专长 迅速识别患者，发送外展消息，进行评估，并促进患者的护理 无法及时开始治疗的抑郁症。干预将通过 目标种族和少数民族人口和提供者的患者。大约400名合格的患者 在两个MHRN中，卫生系统将被随机分为干预组或通常的护理。结果（治疗） 将从卫生系统中确定抑郁缓解和反应的启动和速率） 记录。分析将检查干预参与并比较主要结果（治疗） 启动）和组之间的次要结果（记录的抑郁缓解和反应）。结果 将告知随后的全尺寸务实试验，以评估人口级分布的减少。