IMPROVING PRIMARY CARE SERVICES: PERSONAL ILLNESS MODELS

描述(申请人摘要)：这份修改后的R01申请书将审查 个人疾病模式与抑郁症治疗依从性之间的联系 使用最先进的药物监测技术的初级护理患者。 它还将探讨它们与症状和功能结果的关系。 通过自然主义地考察这些复杂的关系，这项研究将 为设计干预策略奠定基础，促进 在初级保健实践中坚持抑郁症治疗。我们建议 在12个月的时间内检查不遵守药理学规定的程度 初级保健患者抑郁的治疗，并使用Levanthal‘s 自我调节模型对疾病认知的影响评价 抑郁症患者坚持服药的信念或表现。 这项研究使用纵向设计来评估这些感知的变化。 随着时间的推移，210名初级保健患者坚持治疗 18岁及以上的人将从两个家庭实践健康中心和一个 由八个家庭诊所组成的网络。潜在的参与者将是 由其初级保健医生转介的医生将被要求转介 在过去两年内开始接受抗抑郁治疗的患者 几周。提供知情同意的患者将完成五个心理社会问题 12个月期间(即基线和3、6、9和12个月)的评估。 用药依从性将在这些就诊时通过患者自我报告进行评估 和电子药片监测器。 拟议的研究将提供关于 不坚持抗抑郁治疗的初级保健部门在这两次 药物治疗的急性期和持续期。这也将是第一次 抑郁症的疾病表征及其关系的研究 坚持治疗，并评估个人疾病模式的变化 时间到了。这项研究的发现将形成发展的基础 依从性干预，为患者的自我管理需求量身定做。 后续的研究将被设计来评估这种方法的有效性 初级保健部门的干预措施。

DESCRIPTION (Applicant's abstract): This revised R01 application will examine the links between personal illness models and depression treatment adherence in primary care patients using state-of-the-art medication monitoring techniques. It will also explore their relationship to symptomatic and functional outcomes. By examining these complex relationships naturalistically, this research will lay the foundation for the design of intervention strategies to promote adherence to depression treatment in primary care practice. We propose to examine, over a 12-month period, the extent of nonadherence to pharmacologic treatment for depression among primary care patients, and to use Levanthal's self-regulatory model of illness cognition to evaluate the influence of these beliefs or representations of depressive illness on medication adherence. This study uses a longitudinal design to assess changes in these perceptions and treatment adherence over time Two hundred and ten primary care patients age 18 and older will be recruited from two family practice health centers and a network of eight family practice offices. Potential participants will be referred by their primary care physician Physicians will be asked to refer patients who have initiated antidepressant treatment within the preceding two weeks. Patients providing informed consent will complete five psychosocial assessments in a 12-month period (i.e., baseline, and months 3, 6, 9, and 12). Medication adherence will be assessed at these visits by patient self-report and electronic pill monitors. The proposed study will provide important information on patterns of nonadherence to antidepressant treatment the primary care sector during both acute and continuation phases of pharmacotherapy. It will also be the first study to examine illness representations for depression and their relationship to treatment adherence, and to assess change in personal illness models over time. The findings from this study will form the basis for development of adherence interventions, which are tailored to patients' self-management needs. Subsequent studies will be designed to evaluate the effectiveness of such interventions in the primary care sector.