IMPROVING PRIMARY CARE SERVICES: PERSONAL ILLNESS MODELS

描述（申请人的摘要）：此修订后的 R01 申请将审查 个人疾病模型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对初级保健患者进行治疗。 它还将探讨它们与症状和功能结果的关系。 通过自然地审视这些复杂的关系，这项研究将 为干预策略的设计奠定基础，以促进 在初级保健实践中坚持抑郁症治疗。我们建议 检查 12 个月内不遵守药物治疗的程度 治疗初级保健患者的抑郁症，并使用 Levanthal 的 疾病认知的自我调节模型来评估这些因素的影响 抑郁症的信念或表征对药物依从性的影响。 本研究使用纵向设计来评估这些看法的变化 随时间变化的治疗依从性 210 名初级保健患者年龄 将从两个家庭诊所健康中心和一个 由八个家庭诊所组成的网络。潜在的参与者将是 由他们的初级保健医生转介 医生将被要求转介 过去两年内已开始抗抑郁治疗的患者 几周。提供知情同意书的患者将完成五项心理社会 12 个月期间（即基线、第 3、6、9 和 12 个月）的评估。 这些就诊时将根据患者的自我报告评估药物依从性 和电子药丸监视器。 拟议的研究将提供有关模式的重要信息 初级保健部门在这两个时期不坚持抗抑郁治疗 药物治疗的急性期和持续期。这也将是第一个 研究检查抑郁症的疾病表征及其关系 治疗依从性，并评估个人疾病模型的变化 时间。这项研究的结果将成为开发的基础 依从性干预措施，根据患者的自我管理需求量身定制。 后续研究将旨在评估此类措施的有效性 对初级保健部门的干预。

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.