Translating Depression Guidelines in Substance Abuse Tx

将抑郁症指南转化为药物滥用德克萨斯州

基本信息

批准号：
7254763
负责人：
GEOFFREY M CURRAN
金额：
$ 13.79万
依托单位：
UNIV OF ARKANSAS FOR MED SCIS
依托单位国家：
美国
项目类别：
财政年份：
2003
资助国家：
美国
起止时间：
2003-09-30 至 2008-12-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7254763
关键词：
Adoption Agreement Alcohol or Other Drugs use Algorithms American Antidepressive Agents Area Attitude Behavior Belief Caring Clinical Cognitive Therapy Communities Continuity of Patient Care Data Depressive disorder Development Development Plans Diagnosis Diffusion Diffusion of Innovation Drug Metabolic Detoxication Eating Effectiveness Evaluation Foundations Funding Goals Guidelines Healthcare Individual Intervention K-Series Research Career Programs Learning Link Literature Major Depressive Disorder Medical Sociology Mental Depression Mentored Research Scientist Development Award Mentors Methods Organizational Change Organizational Policy Outcome Outcomes and Health Services Research Patients Persons Pharmaceutical Preparations Pharmacotherapy Practice Guidelines Preparation Protocols documentation Provider Psychotherapy Qualitative Methods Quality of life Recommendation Recording of previous events Reporting Research Services Structure Substance Use Disorder Substance abuse problem Symptoms System Technology Transfer Testing Training Translating Translations Treatment Protocols Treatment Step Veterans Week base career depressive symptoms emotional abuse experience health administration implementation research improved knowledge base medication compliance member programs psychosocial skills sobriety theories therapy design tool treatment program

项目摘要

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.

描述（由申请人提供）：申请人通过指导的职业发展奖（K01）计划要求提供五年的资金，以增强他的知识库和方法学技能，以扩散翻新研究，特别是将基于证据的抑郁症护理转化为社区药物使用治疗环境。申请人在医学社会学，毒品使用障碍和健康服务/成果研究方面的强大背景是在这些环境中发展技术转移专业知识的理想基础。拟议的职业发展计划通过在五个领域提供特定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提供护理3）目前的滥用药物和心理保健服务的组织/政策结构，重点是跨系统内部和跨系统的连续性； 4）与拟议的研究计划有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，实施和测试对社区药物滥用治疗环境的组织干预，以建立对合并症抑郁症的指导方案治疗。该干预措施将协助计划自己实施基于指南的治疗算法，以改善对抑郁症和药物治疗的识别。该算法将涉及两个评估对治疗步骤 - 1）抑郁症状的早期毒性后评估以及患者抑郁症的病史，如果患者在清醒期间报告当前的症状和严重抑郁症的病史，则进行药物治疗； 2）抑郁症状在十分毒后至少4周评估，如果指出了对抑郁症的独立诊断，则开始进行药物治疗。从先前的指南实施研究中我们知道，准则的简单传播几乎不会影响提供商/系统行为。相反，对于最大化指南一致行为的采用是必不可少的。研究1分析了参与设施中抑郁管理的技术转移的障碍和促进者。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商级别的结果。计划级别的结果将包括可行性，采用算法的范围，以及有关干预设计和有效性的提供商/组织态度和信念。患者水平的结果将包括抑郁症状，药物使用结果，药物依从性生活质量以及服务使用。