Translating Depression Guidelines in Substance Abuse Tx

将抑郁症指南转化为药物滥用德克萨斯州

• 批准号: 6611563
• 负责人: GEOFFREY M CURRAN
• 金额: $ 12.83万
• 依托单位: UNIV OF ARKANSAS FOR MED SCIS
• 依托单位国家: 美国
• 财政年份: 2003
• 资助国家: 美国
• 起止时间: 2003-09-30 至 2008-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6611563
• 关键词: behavior therapy; behavioral /social science research tag; clinical research; comorbidity; depression; drug abuse chemotherapy; ethics; human subject; interview; outcomes research; quality of life; questionnaires; substance abuse related disorder; training

DESCRIPTION (provided by applicant): The applicant is requesting five years of funding though the Mentored Career Development Award (K01) program to enhance his knowledge base and methodological skills for diffusion of renovation research-- specifically, to translate evidence-based care for depression into community substance use treatment settings. The applicant's strong background in medical sociology, the developmental course of substance use disorders, and health services/outcomes research is an ideal foundation for developing expertise in technology transfer in these settings. The proposed career development plan supports this goal by providing specific training in five areas: 1) organizational change theory and methods; 2) clinical provision of care for substance abuse and depression 3) the current organizational/policy structure of substance abuse and mental healthcare services, focusing on continuity of care within and across systems; 4) quantitative and qualitative methods pertinent to the proposed research plan; and 5) the ethical conduct of research. The research plan seeks to develop, implement, and test an organizational intervention in community substance abuse treatment settings to establish guideline-concordant treatment of comorbid depression. The intervention will assist programs in their own implementation of a guidelines-based treatment algorithm to improve the recognition of depression and initiation of pharmacotherapy. The algorithm will involve two assessment-to-treatment steps-- 1) early post-detoxification assessment of depressive symptoms plus a patient history of depression, with initiation of pharmacotherapy if the patient reports both current symptoms and a history of major depression during periods of sobriety; 2) assessment of depression symptoms at least 4 weeks post-detoxification, with initiation of pharmacotherapy if an independent diagnosis of depression is indicated. We know from previous guideline implementation research that the simple dissemination of guidelines does little to influence provider/system behavior. Rather, a multi-component diffusion of innovation intervention is necessary to maximize the adoption of guideline concordant behavior. Study 1 analyzes the barriers and facilitators to technology transfer of depression management in participating facilities. These data will inform the development of the technology transfer intervention, its implementation tools, and the depression algorithm. Study 2 implements and tests the intervention. The evaluation will examine program- and provider-level outcomes. Program level outcomes will include feasibility, extent of adoption of the algorithm, and provider/organizational attitudes and beliefs about the intervention's design and effectiveness. Patient-level outcomes will include depressive symptoms, substance use outcomes, medication adherence quality of life, and services use.

描述（由申请人提供）： 申请人通过指导职业发展奖（K 01）计划申请五年的资金，以提高他的知识基础和方法技能，以传播创新研究-特别是将基于证据的抑郁症护理转化为社区物质使用治疗环境。申请人在医学社会学，物质使用障碍的发展过程和卫生服务/成果研究方面的强大背景是在这些环境中发展技术转让专业知识的理想基础。拟议的职业发展计划通过在五个领域提供具体培训来支持这一目标：1）组织变革理论和方法; 2）药物滥用和抑郁症的临床护理提供; 3）药物滥用和精神保健服务的当前组织/政策结构，重点是系统内和系统间的护理连续性; 4）与拟议研究计划相关的定量和定性方法;（5）研究的道德行为。该研究计划旨在开发，实施和测试社区药物滥用治疗环境中的组织干预，以建立共病抑郁症的指南一致性治疗。该干预措施将帮助项目实施基于指南的治疗算法，以提高对抑郁症的认识和药物治疗的启动。该程序将包括两个评估到治疗的步骤---- 1）早期戒毒后抑郁症状评估加上患者抑郁症病史，如果患者报告当前症状和清醒期间严重抑郁症病史，则开始药物治疗; 2）戒毒后至少4周评估抑郁症状，如果有独立的抑郁症诊断指征，则开始药物治疗。我们知道，从以前的指导方针的实施研究，简单的传播的指导方针并没有影响供应商/系统的行为。相反，创新干预的多成分扩散是必要的，以最大限度地采用指导方针一致的行为。研究1分析了参与设施中抑郁症管理技术转移的障碍和促进因素。这些数据将为技术转让干预的发展、其实施工具和抑郁算法提供信息。研究2实施并测试了干预措施。评估将审查方案和提供者一级的成果。计划层面的结果将包括可行性、算法的采用程度以及提供者/组织对干预设计和有效性的态度和信念。患者水平的结局将包括抑郁症状、物质使用结局、药物依从性、生活质量和服务使用。