Adherence to Depression Treatment Among Older Patients

老年患者对抑郁症治疗的依从性

• 批准号: 7015074
• 负责人: HILLARY R BOGNER
• 金额: $ 17.6万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2003
• 资助国家: 美国
• 起止时间: 2003-02-20 至 2008-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7015074
• 关键词: behavior therapy; cardiovascular disorder; clinical research; cognition; comorbidity; depression; human subject; human therapy evaluation; interview; patient oriented research; psychiatric patient care

This application for an NIMH Mentored Patient-Oriented Research Career Development Award (K23 Award) seeks support to develop a program of research related to the treatment of depression in older adults with cardiovascular disease (CVD). This application capitalizes on my background in family medicine and clinical epidemiology and proposes activities aimed at developing my ability to design, implement, and evaluate interventions directed at the treatment of depression in older primary care patients with CVD. An intervention for depression designed to address CVD comorbidity would provide a model for integration of depression treatment with care for other chronic medical conditions among older adults in the primary care setting. My knowledge of clinical family medicine, epidemiology, and biostatistics, as well as my experience of implementing a large primary care-based study provide an excellent background for development as an intervention researcher. The University of Pennsylvania offers an outstanding research environment to help accomplish the goals of this K23: (1) to study the patient characteristics that place older adults with depression and CVD at risk for nonadherence to depression treatment; (2) to obtain expertise in advanced statistical methods, e.g. structural equation models and new study designs, both of which are integral to my study of adherence in primary care settings; and, (3) to design interventions for depression among older primary care patients with CVD. In addition to educational activities, this application lays out a research plan unfolding in three phases. Phase I will examine factors associated with adherence to recommended depression therapy in older primary care patients with CVD in an NIMH-funded study designed to test the effectiveness of an intervention aimed at improving the recognition and treatment of depression (the PROSPECT study). The focus will be on how cardiovascular comorbidity, executive and cognitive functioning, beliefs about depression and its treatment, social support, and other patient-level factors are associated with adherence to depression treatment in older primary care patients. In Phase 2, semi-structured interviews of older primary care patients will explore patient concepts of depression in relation to CVD and its treatment and patient preferences for possible strategies aimed at improving adherence to depression treatment. Phase 3 will test the feasibility of a protocol for an intervention aimed at the treatment of older adults with CVD. The protocol will be based on the results from Phases 1 and 2. During Phase 4, the findings from Phases 1, 2, and 3 will guide the final development of an R01 intervention study, sketched out in the final section of this K23. This project will set the stage for the development and implementation of interventions to improve depression treatment adherence among persons with co-existing CVD.

本次申请NIMH指导的以患者为导向的研究职业发展奖(K23奖)旨在支持开发一项与治疗老年心血管疾病(CVD)患者的抑郁症相关的研究计划。这个应用程序充分利用了我在家庭医学和临床流行病学方面的背景，并提出了一些活动，旨在培养我设计、实施和评估针对 老年初级保健心血管病患者抑郁的治疗。旨在解决心血管疾病共病的抑郁症干预措施将提供一种模式，将抑郁症治疗与初级保健环境中老年人的其他慢性疾病护理结合起来。我的临床家庭医学、流行病学和生物统计学知识，以及我实施基于初级保健的大型研究的经验，为我提供了一个极好的 作为一名干预研究人员的发展背景。宾夕法尼亚大学提供了一个出色的研究环境，以帮助实现这项K23的目标：(1)研究使患有抑郁症和心血管疾病的老年人面临不坚持抑郁症治疗的风险的患者特征；(2)获得高级统计方法方面的专业知识，例如结构方程模型和新的研究设计，这两者都是我研究的组成部分 在初级保健环境中坚持；以及，(3)为老年初级保健心血管疾病患者的抑郁设计干预措施。除了教育活动外，该应用程序还列出了分三个阶段展开的研究计划。第一阶段将在NIMH资助的一项研究中检查与老年初级保健心血管疾病患者坚持推荐的抑郁治疗相关的因素，该研究旨在测试旨在改善 抑郁症的认识和治疗(展望研究)。重点将放在心血管共病、执行和认知功能、对抑郁症及其治疗的信念、社会支持和其他患者层面的因素与老年初级保健患者坚持抑郁症治疗的关系上。在第二阶段，对老年初级保健患者的半结构化访谈将探索患者与心血管疾病及其相关的抑郁症的概念。 治疗和患者偏好可能的策略，旨在提高对抑郁症治疗的依从性。第三阶段将测试旨在治疗老年人心血管疾病的干预方案的可行性。该方案将基于第一阶段和第二阶段的结果。在第四阶段，第一阶段、第二阶段和第三阶段的结果将指导R01干预研究的最终发展，该研究在本K23的最后一节中概述。该项目将设置 制定和实施干预措施的阶段，以提高共存的心血管疾病患者对抑郁症治疗的依从性。