Telemonitoring Enhanced Support for Depression Self Management

描述(由申请人提供)：尽管抑郁症护理管理改善了结果，但其广泛应用受到基础设施、报销和干预时间的限制。因此，护理经理往往无法提供许多抑郁症患者所需的时间密集型支持，以实现最佳结果。虽然这一服务差距可以通过家庭护理人员(ICG)的支持部分弥补，但ICG缺乏有效监测患者临床需求和支持他们自我管理的正式工具。由于相互竞争的需求和社会孤立，ICGS还面临照顾者职业倦怠的风险。最后，许多患者没有ICG。我们建议通过一种实际的干预来解决这些问题，这种干预使用低成本的技术来激活抑郁症患者现有的社交网络，以获得自我管理支持，而不需要患者使用计算机。干预措施将患者与“护理伙伴”(CP)联系起来，即愿意与临床医生和任何现有ICG协调支持患者的非家庭家庭成员或密友。通过每周自动远程监护，患者报告他们的情绪和自我管理状态，并接受关于自我管理的量身定做的指导。CP收到相应的更新以及如何最好地支持患者自我管理的指导，并通知初级保健团队临床紧急情况。我们的试点工作证明了干预的可行性和潜在的有效性，使患者持续进行远程监护，成功地发布了CP和临床医生报告，抑郁症状显著减轻。我们现在计划严格评估干预措施在为低收入和保险不足患者提供服务的诊所的抑郁症初级保健患者中的效果，干预措施是专门为这些患者设计的。具体目标1是进行一项随机对照试验，比较一年的远程监护支持的CP治疗抑郁症与常规护理(对照)治疗抑郁症严重程度的效果。具体目标2是检查关键的次要结果(反应和缓解、损害、幸福感、护理负担、医疗费用)和潜在的调节因素。具体目标3是使用混合方法来丰富我们对统计关联的解释，并发现提高干预措施的可接受性、有效性和可持续性的策略。如果干预措施被证明是有效的，而不会增加临床医生的负担或边际成本，那么随后的实施可能会产生重大的公共卫生好处，特别是在医疗服务不足的人群中。社会效益也可以通过促进助人行为和社会关系来实现。后续研究可以实施干预，并将重点扩展到特定的抑郁症亚型以及其他慢性精神障碍。在这份重新提交的提案中，我们通过在我们的团队中增加专业专家、加强对参与者的保护以及提供更多方法细节来回应评审者的反馈。

DESCRIPTION (provided by applicant): Although depression care management improves outcomes, its widespread uptake is hindered by limitations in infrastructure, reimbursement, and interventionist time. As a result, care managers are often unable to provide the time intensive support that many depressed patients need in order to achieve optimal outcomes. While this service gap can be partly offset by support from an in-home caregiver (ICG), ICGs lack formal tools to effectively monitor patients' clinical needs and support their self-management. ICGs are also at risk for caregiver burnout due to competing demands and social isolation. Finally, many patients have no ICG. We propose to address these problems with a practical intervention that uses low cost technologies to activate depressed patients' existing social networks for self-management support, without requiring patients to use a computer. The intervention links patients with a "CarePartner" (CP), i.e., a non-household family member or close friend who is willing to support the patient in coordination with the clinician and any existing ICG. Through weekly automated telemonitoring, patients report their mood and self-management status, and receive tailored guidance on self-management. The CP receives a corresponding update along with guidance on how to best support the patient's self-management efforts, and the primary care team is notified about clinically urgent situations. Our pilot work demonstrates the intervention's feasibility and potential effectiveness, such that patients consistently engaged in telemonitoring, CP and clinician reports were successfully issued, and depressive symptoms reduced significantly. We now plan to rigorously evaluate the intervention's efficacy among depressed primary care patients from clinics serving low-income and underinsured patients, whom the intervention was especially designed to benefit. Specific Aim 1 is to conduct an RCT to compare the effectiveness of one year of telemonitoring-supported CP for depression versus usual care (control) on depression severity. Specific Aim 2 is to examine key secondary outcomes (response and remission, impairment, well-being, caregiving burden, healthcare costs) and potential moderators. Specific Aim 3 is to use a mixed-methods approach to enrich our interpretation of the statistical associations, and to discover strategies to enhance the intervention's acceptability, effectiveness, and sustainability. If the intervention proves effectie without increasing clinician burden or marginal costs, then its subsequent implementation could yield major public health benefits, especially in medically underserved populations. Societal benefit may also occur through the promotion of helping behavior and social ties. Follow-up research could implement the intervention, and extend its focus to specific depression subtypes as well as other chronic psychiatric disorders. In this resubmitted proposal, we respond to Reviewers' feedback by adding specialized experts to our team, strengthening our participant protections, and providing additional methodological details.