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Telephone-Based Depression Care for Rural Latino Primary Care Patients

为农村拉丁裔初级保健患者提供基于电话的抑郁症护理

基本信息

批准号：
7313960
负责人：
EUGENE AISENBERG
金额：
$ 29.54万
依托单位：
UNIVERSITY OF WASHINGTON
依托单位国家：
美国
项目类别：
财政年份：
2007
资助国家：
美国
起止时间：
2007-07-01 至 2009-06-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7313960
关键词：
Address Adherence Administrator Agriculture Area Caring Cities Classification Client satisfaction Clinic Clinical Cognitive Therapy Community Health Centers Depressed mood Depressive disorder Diffusion of Innovation Direct Costs Effectiveness Effectiveness of Interventions Elements Ensure Face Family Generic Drugs Goals Hand Health Health Personnel Health behavior Health system Hispanics Intervention Intervention Studies Interview Knowledge Language Latino Life Low income Managed Care Measures Medical Medical center Mental Depression Mental Health Mental Health Services Metaphor Methods Mexico Modeling Nature Nomads Oregon Outcome Patients Persons Pilot Projects Population Population Heterogeneity Preparation Primary Health Care Provider Psychotherapy Purpose Quality of life Randomized Randomized Controlled Trials Rate Research Research Personnel Risk Behaviors Rural Screening procedure Services Site Structure System Target Populations Telephone Test Result Testing Translating Transportation Travel Universities Washington Week Woman base compliance behavior concept cost cultural values depressive symptoms disability farm worker functional status improved innovation men patient oriented performance site response rural area satisfaction therapy development treatment program

项目摘要

DESCRIPTION (provided by applicant): Among Latinos, depression is underdetected and undertreated. While specific manualized psychotherapies, such as cognitive behavioral therapy (CBT) have been shown effective for Latinos, and many Latinos prefer psychotherapy as first line treatment for depression, few Latinos receive such treatment. Latinos in rural areas face additional barriers to psychotherapy, including lack of available mental health providers and geographic isolation. In order to address these barriers, this proposed pilot will test a telephone-based CBT intervention for depressed low-income Latino primary care patients in rural Eastern Washington State. A manualized telephone CBT intervention shown effective in an urban managed care setting among English-speaking patients has been translated into Spanish and will be minimally adapted and then tested among 80 low-income Latino women and men with depressive disorder who will be identified through systematic screening and randomized to the study intervention vs. usual care. Outcomes will be measured at baseline, 6 weeks, and 3 and 6 months. We will examine the effect of the intervention on: depressive symptoms (the primary outcome) as well as patient-rated improvement, patient satisfaction, disability, and health risk behaviors (secondary outcomes). We will also estimate the direct costs of the intervention. Using qualitative exit interviews of patients and providers, the study will explore socio-cultural and practical barriers to depression care in this population and the need to further adapt the intervention to address these barriers. An expert panel guided by a conceptual model of culturally sensitive clinical interventions for Latino patients will use study results to further adapt and refine the intervention in regards to 8 key elements: language, persons, metaphors, content, concepts, goals, methods, and context. The study's ultimate objective is to develop a culturally appropriate, sustainable, and cost-effective depression treatment program that can be incorporated into routine primary care practices serving low-income rural Latinos and that can be tested in a full scale randomized controlled trial. To our knowledge, ours is the first study to examine the effectiveness of CBT in a rural Latino population. PERFORMANCE SITE(S) (organization, city, state) Yakima Valley Farmworkers Clinic's Family Medical Center, Walla Walla, Washington University of Washington, Seattle, Washington This pilot study tests a telephone-based cognitive behavioral therapy intervention for depressed low-income Latino primary care patients in rural Eastern Washington. It minimally adapts a manualized telephone CBT shown effective in an urban managed care setting. To our knowledge, ours is the first study to examine the effectiveness of CBT in a rural Latino population.

描述（由申请人提供）：在拉丁裔中，抑郁症未被充分发现和治疗。虽然认知行为疗法（CBT）等特定的手动心理疗法已被证明对拉丁裔有效，并且许多拉丁裔更喜欢心理疗法作为抑郁症的一线治疗方法，但很少有拉丁裔接受这种治疗。农村地区的拉丁裔在心理治疗方面面临着额外的障碍，包括缺乏可用的心理健康服务提供者和地理隔离。为了解决这些障碍，拟议的试点项目将测试针对华盛顿州东部农村地区低收入拉丁裔初级保健抑郁症患者的基于电话的 CBT 干预。一项手动电话 CBT 干预措施在城市管理护理环境中对讲英语的患者有效，已被翻译成西班牙语，并将进行最低限度的调整，然后在 80 名患有抑郁症的低收入拉丁裔女性和男性中进行测试，这些人将通过系统筛查进行识别，并随机分配到研究干预组与常规护理组中。结果将在基线、6 周、3 个月和 6 个月时进行衡量。我们将检查干预对以下方面的影响：抑郁症状（主要结果）以及患者评价的改善、患者满意度、残疾和健康风险行为（次要结果）。我们还将估计干预措施的直接成本。通过对患者和提供者进行定性退出访谈，该研究将探讨该人群抑郁症护理的社会文化和实际障碍，以及进一步调整干预措施以解决这些障碍的必要性。以针对拉丁裔患者的文化敏感临床干预概念模型为指导的专家小组将利用研究结果进一步调整和完善有关 8 个关键要素的干预措施：语言、人物、隐喻、内容、概念、目标、方法和背景。该研究的最终目标是开发一种文化上适当、可持续且具有成本效益的抑郁症治疗方案，该方案可以纳入为低收入农村拉丁裔提供服务的常规初级保健实践中，并且可以在全面的随机对照试验中进行测试。据我们所知，我们的研究是第一项检验 CBT 在农村拉丁裔人口中有效性的研究。实施地点（组织、城市、州）亚基马谷农场工人诊所家庭医疗中心，瓦拉瓦拉，华盛顿州华盛顿大学，西雅图，华盛顿州这项试点研究测试了针对华盛顿东部农村低收入拉丁裔抑郁症初级保健患者的基于电话的认知行为治疗干预措施。它最低限度地采用了在城市管理护理环境中显示有效的手动电话 CBT。据我们所知，我们的研究是第一项检验 CBT 在农村拉丁裔人口中有效性的研究。