IMPROVING PRIMARY CARE SERVICES: PERSONAL ILLNESS MODELS

描述（申请人摘要）：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 初级保健患者使用最先进的药物监测技术。 它还将探讨它们与症状和功能结局的关系。 通过自然地研究这些复杂的关系，这项研究将 为制定干预战略奠定基础， 在初级保健实践中坚持抑郁症治疗。我们建议 检查，在12个月的时间内，不遵守药理学的程度， 治疗抑郁症的初级保健患者，并使用Levanthal的 疾病认知的自我调节模型，以评估这些影响 抑郁症对药物依从性的信念或表现。 本研究采用纵向设计来评估这些感知的变化 随着时间的推移和治疗依从性210名初级保健患者年龄 18岁及以上将从两个家庭实践健康中心和一个 八个家庭诊所的网络。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 在前两个月内开始抗抑郁治疗的患者 周提供知情同意书的患者将完成五项社会心理学研究。 12个月内的评估（即，基线和第3、6、9和12个月）。 将在这些访视时通过患者自我报告评估药物依从性 和电子药丸监控器 拟议的研究将提供关于 不依从抗抑郁药治疗的初级保健部门在这两个 药物治疗的急性期和持续期。这也将是第一个 抑郁症的疾病表征及其关系研究 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构成发展的基础， 依从性干预，这是针对患者的自我管理需求。 随后的研究将旨在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.