Translation of comparative effectiveness of depression medications into practice

将抑郁症药物的比较有效性转化为实践

• 批准号: 8007031
• 负责人: VICTOR MANUEL MONTORI
• 金额: $ 149.65万
• 依托单位: MAYO CLINIC ROCHESTER
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-09-01 至 2013-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8007031
• 关键词: Translation; comparative; effectiveness; depression; medications

DESCRIPTION (provided by applicant): At any one time, there are approximately 16 million Americans with depression, a condition associated with decreased quality and diminished duration of life, and with very large costs for society and for the families affected. Lifestyle changes and self-care practices, interpersonal therapy, and pharmacotherapy can improve depression outcomes and lower costs associated with disability. Depression care often demands primary care clinicians' and patients' use of therapy and medication regimens of different efficacy, safety, cost, and burden to the patient. Comparative effectiveness reviews and clinician and patient guides have become available and can inform patients and clinicians about the relative merits of the available options. Decision aids are tools that could help translate evidence from these CERs into practice by helping clinicians involve patients in making deliberate choices based on accessible information about the options available and their outcomes. Our group has developed and evaluated innovative decision aids for treatment of chronic disease in primary care practices and found that their use promoted patient involvement in choice and adherence to treatment. To determine the ability of decision aids to effectively translate a depression CER into practice, we propose to develop a literacy-sensitive depression treatment decision aid, Depression Choice, that would adapt AHRQ's Effective Healthcare CER and associated patient guide about antidepressant medicines (AHRQ 07-EHC007) to satisfy the needs of clinicians, patients and other major stakeholders (health plans, payers). We also propose a randomized study to estimate the effectiveness of the decision aid on patient knowledge, patient involvement in decision-making and decision-making quality, and 6-month measures of medication adherence and mental health, when compared with usual care. Upon completion of the proposed research, we will have translated the Effective Healthcare CER of depression treatment into a point-of-care decision aid and will have acquired new knowledge about the effectiveness of this decision aid in primary care practices. PUBLIC HEALTH RELEVANCE: (Lay language) Routinely, patients with major depression do not have accessible information about the pros and cons of antidepressants, do not participate in choosing the medicine they will take, do not take their antidepressant, and enjoy less than maximum benefit from this treatment. In this study, a multidisciplinary team plans to adapt the available summary of evidence about antidepressants produced by the AHRQ for use as a decision aid -- a tool that helps patients, including those with low health literacy, understand the pros and cons of these medicines. With active participation from patients, clinicians, and other stakeholders, we will develop the decision aid and test its efficacy in primary care. We hypothesize that use of the decision aid will improve patient knowledge about the options, increase the chance that patients will stick to their choice over time by choosing a medicine that better fits with their context and preferences, and improve their depression outcomes.

在任何时候，都有大约1600万美国人患有抑郁症，这种疾病与生活质量下降和寿命缩短有关，并且对社会和受影响的家庭造成非常大的成本。生活方式的改变和自我护理的做法，人际治疗，药物治疗可以改善抑郁症的结果和降低与残疾相关的成本。抑郁症治疗通常要求初级保健医生和患者使用不同疗效、安全性、成本和患者负担的治疗和药物方案。比较有效性审查以及临床医生和患者指南已经可用，可以告知患者和临床医生可用选项的相对优点。决策辅助工具是一种工具，可以帮助临床医生根据有关可用选项及其结果的可访问信息，让患者参与做出深思熟虑的选择，从而将这些CER的证据转化为实践。我们的小组已经开发和评估了创新的决策辅助工具，用于治疗慢性病的初级保健实践，并发现他们的使用促进了患者参与选择和坚持治疗。为了确定决策辅助工具有效地将抑郁症CER转化为实践的能力，我们建议开发一种识字敏感的抑郁症治疗决策辅助工具，抑郁症选择，这将适应AHRQ的有效医疗保健CER和相关的抗抑郁药物患者指南（AHRQ 07-EHC 007），以满足临床医生，患者和其他主要利益相关者（健康计划，付款人）的需求。我们还提出了一项随机研究，以评估与常规护理相比，决策辅助对患者知识，患者参与决策和决策质量以及6个月的药物依从性和心理健康措施的有效性。在完成拟议的研究后，我们将把抑郁症治疗的有效医疗保健CER转化为即时决策辅助工具，并将获得有关这种决策辅助工具在初级保健实践中的有效性的新知识。 公共卫生相关性：（外行语言）然而，重度抑郁症患者没有关于抗抑郁药的利弊的可访问信息，不参与选择他们将服用的药物，不服用抗抑郁药，享受不到最大的好处从这种治疗.在这项研究中，一个多学科团队计划将AHRQ制作的关于抗抑郁药的现有证据摘要用作决策辅助工具-这是一种帮助患者（包括健康素养低的患者）了解这些药物的利弊的工具。在患者、临床医生和其他利益相关者的积极参与下，我们将开发决策辅助工具，并测试其在初级保健中的功效。我们假设，使用决策辅助工具将提高患者对选择的了解，增加患者通过选择更适合其背景和偏好的药物来坚持其选择的机会，并改善其抑郁结果。