Translating Depression Guidelines in Substance Abuse Tx

描述（由申请人提供）： 申请人请求通过指导职业发展奖（K01）计划提供五年的资金，以增强他的知识基础和方法技能，以传播革新研究——具体来说，是将抑郁症的循证护理转化为社区药物使用治疗环境。申请人在医学社会学、物质使用障碍的发展过程以及卫生服务/结果研究方面的深厚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提供五个领域的具体培训来支持这一目标：1）组织变革理论和方法； 2) 针对药物滥用和抑郁症的临床护理服务 3) 当前药物滥用和精神保健服务的组织/政策结构，重点关注系统内和系统间护理的连续性； 4）与拟定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措施，以建立符合指南的共病抑郁症治疗方法。该干预措施将协助项目实施基于指南的治疗算法，以提高对抑郁症的认识并启动药物治疗。该算法将涉及两个从评估到治疗的步骤——1)早期戒毒后评估抑郁症状和患者抑郁病史，如果患者在清醒期间报告当前症状和重度抑郁病史，则开始药物治疗； 2) 戒毒后至少 4 周评估抑郁症状，如果需要独立诊断抑郁症，则开始药物治疗。我们从之前的指南实施研究中得知，指南的简单传播对提供者/系统的行为影响不大。相反，创新干预的多成分扩散对于最大限度地采用指南一致行为是必要的。研究 1 分析了参与机构抑郁症管理技术转让的障碍和促进因素。这些数据将为技术转移干预、其实施工具和抑郁算法的开发提供信息。研究 2 实施并测试干预措施。评估将检查计划和提供者层面的成果。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。患者层面的结果将包括抑郁症状、物质使用结果、药物依从性、生活质量和服务使用。

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.