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.

描述(由申请人提供)：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持续时间缩短有关，并给社会和受影响的家庭带来了非常大的代价。生活方式的改变和自我护理实践、人际关系治疗和药物治疗可以改善抑郁症的结果，并降低与残疾相关的成本。抑郁症的护理通常需要初级保健临床医生和患者使用不同的疗效、安全性、成本和患者负担的治疗和用药方案。比较有效性审查和临床医生和患者指南已经可用，并可以向患者和临床医生告知可用选择的相对优点。决策辅助工具可以帮助临床医生根据可获得的关于可用选项及其结果的信息，让患者参与做出深思熟虑的选择，从而帮助将这些CER中的证据转化为实践。我们小组开发和评估了初级保健实践中用于慢性疾病治疗的创新决策辅助工具，并发现它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将抑郁症CER有效地转化为实践的能力，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，它将调整AHRQ的有效医疗CER和相关的抗抑郁药物患者指南(AHRQ 07-EHC007)，以满足临床医生、患者和其他主要利益相关者(健康计划、支付者)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，决策辅助在患者知识、患者参与决策和决策质量以及6个月用药依从性和心理健康方面的有效性。在拟议的研究完成后，我们将把抑郁症治疗的有效医疗CER转化为医疗保健点决策辅助工具，并将获得关于该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：(通俗语言)通常情况下，重度抑郁症患者无法获得有关抗抑郁药利弊的信息，不参与选择他们将服用的药物，不服用他们的抗抑郁药，并且享受不到这种治疗的最大好处。在这项研究中，一个多学科团队计划将AHRQ生产的关于抗抑郁药物的现有证据摘要用作决策辅助工具--这是一种帮助患者，包括那些健康素养较低的患者，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效果。我们假设，使用决策辅助将提高患者对各种选择的了解，增加患者通过选择更适合他们的背景和偏好的药物，随着时间的推移坚持他们的选择的机会，并改善他们的抑郁结果。