MUPS in Primary Care Research Center

描述（由申请人提供）：这是对PAR 01-090的响应，为干预和服务研究发展中心（DCISR）提供资金的请求。这个新中心将专注于那些在初级保健中出现医学上无法解释的身体症状（MUPS）的患者。MUPS（例如，不明原因的疼痛、麻木、胃肠道症状）包括初级保健环境中致残性精神障碍的非常常见的临床表现，例如抑郁和焦虑。这个新的开发中心的名称将是“MUPS在初级保健研究中心”（MUPS-PCRC）。该中心将建立必要的核心（例如，业务，方法，培训）和基础设施，以发展创新的服务研究计划，在初级保健有关的人口。此外，计划用于MUPS-PCRS的初步研究将涉及社会经济地位较低的拉丁美洲人和非洲裔美国人患者，因为这些人群在精神卫生保健方面存在有据可查的差异。MUPS-PCRS的教师还将探索一种文化能力，协作的分步护理模式对治疗MUPS初级保健患者的有效性，同时研究患者，家庭成员，医生和行为健康护理专家如何接受这种模式。 在与一个由主要研究人员组成的外部咨询委员会协商后，计划进行至少四项试点研究，并加快研究基础设施的实施。这些研究将收集关于协作式分步护理模式不同阶段的初步数据。一项研究将侧重于开发和测试专门的视频和其他教育材料，用于模型的第一阶段，而另一项研究将侧重于认知行为疗法（CBT）作为第二阶段治疗策略的有效性，并作为促进行为健康护理转诊的一种方式。另外两项研究涉及对CBT反应不佳的患者的替代第三阶段治疗：a）心率变异性生物反馈治疗残余抑郁症和躯体主诉; B）人际治疗。我们的期望是，在中心运营的头几年进行的各种研究中收集的初步数据将为MUPS-PCRC教师和学员的几个大规模研究者发起的赠款申请的设计和规划提供信息。

DESCRIPTION (provided by applicant): This is a request for funding a Developing Center for Intervention and Services Research (DCISR) in response to PAR 01-090. This new center will focus on patients who present in primary care with medically unexplained physical symptoms (MUPS). MUPS (e.g., unexplained pain, numbness, gastrointestinal symptoms) comprise a very common clinical presentation for disabling psychiatric disorders in primary care settings, such as depression and anxiety. The name of this new Developing Center will be the "MUPS in Primary Care Research Center" (MUPS-PCRC.) The center will build the necessary cores (e.g., operations, methods, training) and infrastructure for developing an innovative services research program in primary care concerning this population. Furthermore, the initial studies planned for the MUPS-PCRS will relate to lower socioeconomic status Latino and African-American patients, due to the well-documented disparities in mental health care for these populations. The faculty of MUPS-PCRS will also explore the effectiveness of a culturally- competent, collaborative stepped-care model for treating primary care patients with MUPS, while examining how patients, family members, physicians and behavioral health care specialists accept this model. At least four pilot studies are planned, in consultation with an external advisory board of leading researchers, and apace with research infrastructure implementation. These studies will gather preliminary data on different stages of the collaborative stepped-care model. One study will focus on development and testing of specialized videos and other educational materials to be used in the first stage of the model, whereas another study will focus on the effectiveness of cognitive behavioral therapy (CBT) as a second stage treatment strategy and as a way to facilitate behavioral health care referrals. Two other studies concern alternative third-stage treatments for patients who do not respond well to CBT: a) heart rate variability biofeedback for the treatment of residual depression and somatic complaints; b) interpersonal therapy. The expectation is that preliminary data collected in the various studies conducted in the first few years of Center operations will inform the design and planning of several larger-scale investigator -initiated grant applications from MUPS-PCRC faculty and trainees.