Adherence to Antidepressant Medication and Hypertension Treatment

坚持抗抑郁药物和高血压治疗

• 批准号: 7990392
• 负责人: HILLARY R BOGNER
• 金额: $ 23.76万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-12-01 至 2012-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7990392
• 关键词: Address; Adherence; Adult; Adverse effects; Affect; Antidepressive Agents; Antihypertensive Agents; Atherosclerosis; Blood Pressure; Cardiovascular Diseases; Cardiovascular system; Caring; Chronic; Clinical effectiveness; Comorbidity; Congestive Heart Failure; Consumption; Coronary heart disease; Country; Data; Development; Diagnosis; Diastolic blood pressure; Disease remission; Effectiveness; Effectiveness of Interventions; Elderly; Endogenous depression; Enrollment; Evaluation; Event; Future; Goals; Grant; Healthcare; Heart Diseases; Heavy Drinking; Human Resources; Hypertension; Impaired cognition; Intervention; Lead; Licensed Practical Nurse; Life Style; Longitudinal Studies; Major Depressive Disorder; Manic; Medical; Mental Depression; Mental disorders; Mentored Patient-Oriented Research Career Development Award; Mentors; Minority; Modeling; Monitor; Moods; Morbidity - disease rate; Myocardial Infarction; Myocardial Ischemia; National Institute of Mental Health; Obesity; Outcome; Participant; Patients; Persons; Pharmaceutical Preparations; Phase; Physicians; Play; Positioning Attribute; Prevalence; Primary Care Physician; Primary Health Care; Process; Psychosocial Stress; Public Health; Publishing; Randomized Controlled Trials; Recruitment Activity; Reporting; Research; Research Project Grants; Resources; Risk; Risk Factors; Role; Sampling; Services; Site; Sodium; Staging; Strategic Planning; Stroke; Surveys; Sympathetic Nervous System; System; Testing; Time; Training; Tricyclic Antidepressive Agents; United States; Work; World Health Organization; aged; behavior change; blood pressure regulation; cardiovascular disorder risk; cardiovascular risk factor; career development; clinically significant; comparative efficacy; depressive symptoms; design; diabetic patient; disability; functional decline; geriatric depression; human old age (65+); hypertension control; hypertension treatment; improved; innovation; meetings; mortality; non-diabetic; older patient; patient oriented research; physical conditioning; primary care setting; primary outcome; programs; protocol development; psychosocial; public health relevance; research study; response; social; suicide rate; therapy design; therapy development; treatment as usual

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.

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验数据，以评估干预措施，其中包括关注依从性，因为对抑郁症治疗的依从性差仍然是改善护理的重大障碍，特别是在高血压等合并症的情况下。培训已经在实践中工作的执业护士（LPNs）进行干预，将促进其在资源有限和需求竞争的真实的世界实践中的部署。这项建议在基层医疗环境中实施的主要目的是：（1）设计一个综合干预策略，由已经在实践中工作的本地专业护士实施，以通过整合抑郁症和高血压的管理来提高老年基层医疗患者抗高血压治疗的依从性，从而提高抗抑郁治疗的依从性;（2）通过招募100名年龄在65岁及以上、患有临床显著抑郁症且收缩压（BP）> 100的成年人，测试由已经在实践中工作的LPN实施的综合干预策略的可行性并初步评估其有效性。对于非糖尿病患者，收缩压> 140 mmHg或舒张压（BP）> 90 mmHg，或对于糖尿病患者，收缩压> 130或舒张压> 80。未来R 01的主要结局是抑郁反应和缓解、对适当降压治疗的依从性和血压控制改善;和（3）使用本开发研究的数据开发R 01，用于全-规模随机对照试验的干预进行了LPN谁已经在实践中，整合抑郁症和高血压管理工作。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的整合;（2）提供个性化计划，以提高抗抑郁药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。该项目可能会产生重大的公共卫生影响，因为我们正在测试由执业护士（LPN）进行的综合干预，这可能有助于在资源有限和需求竞争的真实的世界实践中部署。 公共卫生相关性：这项提案的目标是将抑郁症治疗纳入高血压护理，以便一个单一的计划可以帮助抑郁症和高血压患者。抑郁症干预旨在解决高血压，心血管疾病的一个主要因素，将提供一个模型，抑郁症治疗与护理其他慢性疾病的老年人在初级保健环境。该项目可能会产生重大的公共卫生影响，因为我们正在测试由执业护士（LPN）进行的综合干预，这可能有助于在资源有限和需求竞争的真实的世界实践中部署。