Adherence to Antidepressant Medication and Hypertension Treatment

描述(由申请人提供)：这项服务R34研究将提供重要的有效性试点数据，以评估包括对坚持的关注的干预措施，因为对抑郁症治疗的坚持不佳仍然是改善护理的重大障碍，特别是在高血压等合并身体状况的背景下。培训已经在执业中工作的执业护士(LPN)进行干预，将有助于将其部署到资源有限和需求相互竞争的现实世界的实践中。这项建议将在初级保健环境中实施的主要目标是：(1)设计一种综合干预策略，由已经在实践中工作的LPN执行，以通过综合管理抑郁症和高血压来提高老年初级保健患者对抗抑郁治疗的依从性；(2)测试综合干预策略的可行性，并初步评估LPN实施的综合干预策略的有效性，这些LPN已经在实践中努力研究坚持足够的抗抑郁药物治疗的主要结果，招募了100名年龄在65岁及以上的临床上有明显抑郁症且非糖尿病患者的收缩压(BP)&GT；140毫米汞柱或舒张压(BP)&GT；90毫米汞，或糖尿病患者的收缩压(BP)&>130或舒张压(BP&>T；80)的成年人。将成为未来R01的主要结果的探索性结果将是抑郁症的反应和缓解、坚持适当的抗高血压治疗以及改善血压控制；以及(3)使用来自这项发展研究的数据开发R01，用于由已经从事整合抑郁症和高血压管理实践的LPN进行的干预的全面随机对照试验。综合护理干预的关键组成部分是：(1)将抑郁症治疗与高血压管理相结合；(2)提供个体化计划，以提高患者对抗抑郁和抗高血压药物的依从性，并认识到患者的社会和文化背景。这个项目可能会对公共卫生产生重大影响，因为我们正在测试一种由执业护士(LPN)进行的综合干预措施，这可能会促进其在资源有限和相互竞争的需求的现实世界实践中的部署。 公共卫生相关性：这项建议源于NIMH指导的以患者为导向的研究职业发展奖(K23)，其目标是将抑郁症治疗整合到高血压的护理中，以便单一计划可以帮助患有抑郁症和高血压的患者。旨在解决高血压的抑郁症干预措施将提供一个模式，将抑郁症治疗与初级保健环境中老年人的其他慢性疾病护理结合起来。高血压是心血管疾病的一个主要因素。这个项目可能会对公共卫生产生重大影响，因为我们正在测试一种由执业护士(LPN)进行的综合干预措施，这可能会促进其在资源有限和相互竞争的需求的现实世界实践中的部署。

DESCRIPTION (provided by applicant): This services R34 research study will provide important effectiveness pilot data to assess an intervention that includes a focus on adherence because poor adherence to depression treatment remains a significant impediment to improving care, in particular in the context of co morbid physical conditions such as hypertension. Training Licensed Practical Nurses (LPNs) who are already working in the practices to carry out the intervention will facilitate its deployment in real world practices with limited resources and competing demands. The primary aims of this proposal to be carried out in the primary care setting are: (1) Design an integrated intervention strategy to be carried out by LPNs who are already working in the practices to improve adherence to antidepressant treatment in the context of improving adherence to antihypertensive treatment for older primary care patients through integration of management of both depression and hypertension; (2) Test the feasibility and assess in a preliminary fashion the effectiveness of the integrated intervention strategy carried out by LPNs who are already working in the practices on the primary outcome of adherence to adequate antidepressant treatment by enrolling 100 adults aged 65 years and older with clinically significant depression and a systolic blood pressure (BP) > 140 mmHg or diastolic blood pressure (BP) > 90 mmHg for non-diabetics, or a systolic BP > 130 or a diastolic BP > 80 for diabetic patients. Exploratory outcomes that will be the primary outcomes of the future R01 will be depression response and remission, adherence to adequate antihypertensive treatment, and improved blood pressure control; and (3) Use data from this developmental study to develop an R01 for a full-scale randomized controlled trial of the intervention carried out by LPNs who are already working in the practices that integrates depression and hypertension management. The key components of the Integrated Care Intervention are: (1) integration of depression treatment with hypertension management; and (2) provision of an individualized program to improve adherence to antidepressant and antihypertensive medications that recognizes patients' social and cultural context. This project can have a significant public health impact because we are testing an integrated intervention to be carried out by Licensed Practical Nurses (LPNs) that may facilitate its deployment in real world practices with limited resources and competing demands. PUBLIC HEALTH RELEVANCE: The goal of this proposal which grows out of an NIMH Mentored Patient-Oriented Research Career Development (K23) Award is to integrate depression treatment into care for hypertension so that a single program can assist the patients with depression and hypertension. A depression intervention designed to address hypertension, a major factor for CVD, would provide a model for integration of depression treatment with care for other chronic medical conditions among older adults in primary care settings. This project can have a significant public health impact because we are testing an integrated intervention to be carried out by Licensed Practical Nurses (LPNs) that may facilitate its deployment in real world practices with limited resources and competing demands.