Web-Based Program to Improve Antidepressant Medication Adherence

基于网络的提高抗抑郁药物依从性的计划

基本信息

批准号：
8199748
负责人：
REBEKAH K HERSCH
金额：
$ 14.97万
依托单位：
ISA ASSOCIATES, INC.
依托单位国家：
美国
项目类别：
财政年份：
2011
资助国家：
美国
起止时间：
2011-09-15 至 2012-12-14
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8199748
关键词：
18 year old Address Adherence Adult Adverse effects Affect Age American Antidepressive Agents Anxiety Appointment Behavioral Sciences Benchmarking Bipolar Disorder Clinical Collaborations Communication Complex Counseling Country Data Dependence Development Diagnosis Disease Dysthymic Disorder Family Fright Goals Guidelines Health Healthcare Income Individual Instruction Internet Intervention Interview Knowledge Life Major Depressive Disorder Manuals Measures Medical center Mental Depression Mental Health Mental disorders Methods Modeling Mood Disorders Moods Nature Online Systems Oral Outcome Outcome Measure Participant Patient Self-Report Patients Pharmaceutical Preparations Pharmacy facility Phase Physicians Population Prevention program Problem Solving Productivity Program Development Psychiatry Psychology Randomized Randomized Controlled Trials Relapse Relative (related person)Research Risk Role Sampling Self Efficacy Stress Surveys Telephone Testing Time Treatment Effectiveness Treatment Protocols Universities Washington Work Writing base behavioral health burden of illness collaborative care compliance behavior coping cost design disability disability-adjusted life years dosage health care service utilization improved innovation medical schools medication compliance meetings member misuse of prescription only drugs outreach pill professor programs prototype

项目摘要

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.

描述（由申请人提供）：情绪障碍，包括重度抑郁症，心律失常和躁郁症，影响了近2100万美国人，占18岁及以上的美国人口的9.5％。在心理健康问题中，主要的抑郁症是美国15-44岁人民的残疾主要原因，每年影响近1500万成年人。尽管研究清楚地表明，根据国家准则服用药物时，抗抑郁药治疗严重抑郁症的功效，但当患者不服用处方药时，疗效就会受到损害。对抗抑郁药的不遵守估计范围为20％至59％。不遵守的原因范围从不良副作用，完成治疗过程之前的临床改善，对服用精神药物的不适感，缺乏治疗有效性以及解决没有药物的问题的愿望。为了改善患者对治疗方案的依从性，已经实施了许多干预措施，但是最有效的计划通常是复杂的，劳动力密集的领导麦当劳及其同事得出结论，需要对创新方法进行更多的研究。 ISA Associates与Aetna行为医疗保健和Redmon Group合作，建议开发和进行试验测试基于Web的原型抗抑郁药依从性计划，抑郁症的生命步骤，适用于诊断患有严重抑郁症和处方药抗抑郁药的人。该原型将基于Safren成功的生命步骤药物依从性方法。一旦开发了原型，它将通过60位AETNA行为卫生成员的样本进行试验，这些样本是新开处方的抗抑郁药，并对重度抑郁症的诊断相应地诊断。由于原型的性质有限，其中只能完全开发最终程序内容的样本，因此可行性将基于与原型内容相关的自我报告的结果指标。这些措施将包括抑郁，药物和依从性知识；感知的患者 - 医学疗法相互作用的功效；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。描述了I阶段的里程碑和基准进行II阶段。如果显示出有效的话，所有开处方的抗抑郁药的抑郁症的生命步骤将用于抑郁症，可以使用互联网，从而大大扩大了药物依从性计划的影响力。提议的研究团队在内，包括Drs。 Hersch和Billings已成功创建并测试了几个基于Web的行为健康计划，包括Smart RX（处方药滥用预防计划）以及压力和情绪管理（解决了有效的压力，抑郁，焦虑，焦虑和治疗方法）。博士。 Hersch and Billings将由哈佛医学院心理学副教授，《生命步骤方法的开发商》史蒂夫·萨夫伦（Steve Safren）博士，精神病学教授兼精神病学和行为科学系副主席韦恩·卡顿（Wayne Katon）博士的协助。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可用于治疗重度抑郁症。但是，由于多种原因，许多人未能完成最低建议的六个月治疗方案。最近的数据表明，有协作护理和电话外展方法可以提高药物依从性并改善临床结果。不幸的是，这些干预措施的覆盖范围受其成本和相对无法获得的限制。该阶段项目的结果将是针对诊断为患有抗抑郁药治疗的重度抑郁症患者的创新，基于网络的药物依从性计划的原型。这样的计划（如果有效）将大大扩展对有效的药物依从性计划的机会，从而改善抑郁症患者的临床结果并减少抑郁症复发的可能性。