Web-Based Program to Improve Antidepressant Medication Adherence

描述（由申请人提供）：心境障碍，包括重度抑郁症、心境恶劣和双相情感障碍，影响近2100万美国人或美国18岁及以上人口的9.5%。在心理健康问题中，重度抑郁症是美国15 - 44岁人群残疾的主要原因，每年影响近1500万成年人。虽然研究清楚地表明，当按照国家指导方针服用药物时，抗抑郁药物治疗重度抑郁症的疗效，但当患者不按规定服用药物时，这种疗效就会受到影响。估计不依从抗抑郁药物的比例为20%至59%。不依从的原因包括不良副作用、完成疗程前的临床改善、对依赖性的恐惧、服用精神药物的不适、缺乏治疗效果以及希望在没有药物的情况下解决问题。为了提高患者对治疗方案的依从性，已经实施了许多干预措施，但最有效的方案往往是复杂和劳动密集型的，这使得McDonald和她的同事得出结论，需要更多的创新方法研究。ISA Associates与Aetna Behavioral Health Care和雷德蒙集团合作，提议为被诊断患有重度抑郁症并开出抗抑郁药的个人开发并试点测试一个基于网络的抗抑郁药物依从性原型计划--Life Steps for Depression。药物。原型将基于Safren成功的Life Steps药物依从性方法。一旦原型开发出来，它将与60名安泰行为健康成员的样本进行试点测试，这些成员是新处方的抗抑郁药物，并有相应的重度抑郁症诊断。由于原型的有限性，其中只有一个样本的最后方案内容将得到充分发展，可行性将根据自我报告的成果措施有关的原型内容。这些措施将包括抑郁症，药物和依从性的知识;患者-医生互动中的感知疗效;应对副作用;药物依从性自我效能;[和药物依从性]。参与者将在基线和两个月内完成调查。第一阶段的里程碑和基准进行到第二阶段的描述。如果证明有效，基于网络的抑郁症生活步骤将提供给所有个人处方抗抑郁药物的抑郁症与访问互联网，大大扩大了药物依从性计划的范围。包括Hersch和Billings博士在内的拟议研究团队已经成功创建并测试了几个基于网络的行为健康计划，包括Smart Rx（处方药滥用预防计划）和压力和情绪管理（解决压力，抑郁，焦虑和有效的治疗）。Hersch博士和Billings博士将由哈佛医学院心理学副教授、Life Steps方法的开发者Steve Safren博士和华盛顿大学医学中心精神病学教授、精神病学和行为科学系副主任韦恩卡通博士协助。 公共卫生相关性：临床证据现在表明，有安全有效的抗抑郁药物可用于治疗重度抑郁症。然而，由于各种原因，许多人未能完成最低推荐的六个月治疗方案。最近的数据表明，有协作护理和电话外展的方法，可以提高药物治疗的依从性和改善临床结果。不幸的是，这些干预措施的范围受到其成本和相对难以获得的限制。这个第一阶段项目的结果将是一个创新的，基于网络的药物依从性计划的原型，用于被诊断患有严重抑郁症的个人，他们正在接受抗抑郁药物治疗。这样的计划，如果有效，将大大扩大获得有效的药物依从性计划，从而改善抑郁症患者的临床结果，降低抑郁症复发的可能性。

DESCRIPTION (provided by applicant): Mood disorders, including major depressive disorder, dysthymia, and bipolar disorder, affect nearly 21 million Americans or 9.5% of the U.S. population age 18 years of age and older. Among mental health problems, major depressive disorder is the leading cause of disability in the U.S. for people ages 15-44, affecting nearly 15 million adults each year. While research has clearly shown the efficacy of antidepressant medication for treating major depression when medications are taken in accordance with national guidelines, that efficacy is compromised when patients do not take medications as prescribed. Estimates for non-adherence to antidepressant medications range from 20% to 59%. Reasons for non-adherence range from adverse side effects, clinical improvement prior to completing treatment course, fear of dependence, discomfort with taking psychotropic medications, lack of treatment effectiveness, and desire to solve problems without drugs. Many interventions have been implemented in an attempt to improve patient adherence to treatment regimens, but the most effective programs are often are often complex and labor intensive leading McDonald and her colleagues to conclude that more studies of innovative methods are needed. ISA Associates, in partnership with Aetna Behavioral Health Care and the Redmon Group, proposes to develop and pilot test a prototype web-based antidepressant medication adherence program, Life Steps for Depression, for individuals diagnosed with major depressive disorder and prescribed antidepressant medication. The prototype will be based on Safren's successful Life Steps medication adherence approach. Once the prototype is developed, it will be pilot tested with a sample of 60 Aetna Behavioral Health members who are newly prescribed antidepressant medication and have a corresponding diagnosis of major depressive disorder. Because of the limited nature of the prototype, in which only a sample of the final program content will be fully developed, feasibility will be based on self-reported outcome measures related to the prototype content. These measures will include knowledge of depression, medications, and adherence; perceived efficacy in patient-physician interactions; coping with side effects; medication adherence self-efficacy; [and medication adherence]. Participants will complete the survey at baseline and two months. Phase I milestones and benchmarks for proceeding to Phase II are described. If shown effective, the web-based Life Steps for Depression would be available to all individuals prescribed antidepressant medications for depression with access to the Internet, greatly expanding the reach of medication adherence programs. The proposed research team including Drs. Hersch and Billings have successfully created and tested several web-based behavioral health programs, including Smart Rx (a prescription drug misuse prevention program) and Stress and Mood Management (which addresses stress, depression, anxiety, and treatments that work). Drs. Hersch and Billings will be assisted by Dr. Steve Safren, Associate Professor in Psychology, Harvard Medical School and developer of the Life Steps approach, and Dr. Wayne Katon, Professor of Psychiatry and Vice Chair of the Department of Psychiatry and Behavioral Sciences at the University of Washington Medical Center. PUBLIC HEALTH RELEVANCE: Clinical evidence now shows that there are safe and effective antidepressant medications that can be used to treat major depressive disorder. However, many individuals fail to complete the minimum recommended six month treatment regimen for a wide variety of reason. Recent data suggests that there are collaborative care and telephone outreach approaches that can increase medication compliance and improve clinical outcomes. Unfortunately, the reach of these interventions is limited by their cost and relative inaccessibility. The outcome of this Phase I project will be a prototype of an innovative, web-based medication adherence program for individuals diagnosed with major depressive disorder who are being treated with antidepressant medications. Such a program, if effective, will greatly expand access to an effective medication adherence program, thereby improving the clinical outcomes of people with depression and reducing the likelihood of depression relapse.