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，大约有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，给社会和受影响的家庭带来了巨大的成本。生活方式的改变和自我保健实践、人际治疗和药物治疗可以改善抑郁症的预后，降低与残疾相关的费用。抑郁症护理通常需要初级保健临床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。现在已经有了比较疗效评价和临床医生和患者指南，可以让患者和临床医生了解现有选择的相对优点。决策辅助工具是一种工具，可以帮助临床医生根据可获得的关于可用选择及其结果的信息，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。我们的小组开发并评估了在初级保健实践中治疗慢性病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有效转化为实践的能力，我们建议开发一种对读写能力敏感的抑郁症治疗决策辅助工具“抑郁症选择”，它将改编AHRQ的《有效医疗保健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、支付方）的需求。我们还提出了一项随机研究，以评估决策辅助在患者知识，患者参与决策和决策质量方面的有效性，以及与常规护理相比，6个月的药物依从性和心理健康措施。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转化为护理点决策辅助工具，并将获得有关该决策辅助工具在初级保健实践中的有效性的新知识。