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，以评估干预措施，包括关注依从性，因为抑郁症治疗依从性差仍然是改善护理的重大障碍，特别是在高血压等共病身体状况的背景下。培训已经在实践中开展干预工作的持牌执业护士（lpn）将促进其在资源有限和需求竞争的现实世界实践中的部署。本研究的主要目的是在初级保健环境中实施：(1)设计一个综合干预策略，由已经在实践中工作的lpn执行，通过整合抑郁症和高血压的管理来提高老年初级保健患者抗抑郁治疗的依从性；(2)通过招募100名65岁及以上患有临床显著抑郁症且收缩压（BP）为140 mmHg或舒张压（BP）为90 mmHg的非糖尿病患者，对已经在实践中坚持适当抗抑郁治疗的lpn实施的综合干预策略的可行性和有效性进行初步评估。糖尿病患者收缩压130或舒张压80。探索性结局将是未来R01的主要结局，抑郁反应和缓解，坚持适当的抗高血压治疗，改善血压控制；(3)利用本发展性研究的数据，为已经从事抑郁症和高血压综合管理实践的lpn进行干预的全面随机对照试验制定R01。综合护理干预的关键组成部分是：(1)抑郁症治疗与高血压管理相结合；(2)提供个性化方案，提高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。该项目可以对公共卫生产生重大影响，因为我们正在测试一项由持牌执业护士（lpn）实施的综合干预措施，这可能有助于在资源有限和需求竞争的现实世界实践中进行部署。

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.