The Depression Hypertension COACH Study

描述（由申请人提供）：中国老年人抑郁症/高血压-健康合作（COACH）研究是一项随机对照试验（RCT），比较COACH干预与CAU干预对中国农村老年人抑郁症和HTN的治疗效果。COACH将老年人初级保健提供者（PCP）提供的护理与老年工作者（AW；村里老龄协会的非专业成员）提供的护理结合起来，由精神科医生顾问监督。根据慢性病管理原则，PCP接受培训，使用循证实践指南治疗HTN和抑郁症，并获得关于患者抑郁症最佳管理的心理健康咨询。接受培训的老年护理人员可对老年人的社会环境进行系统评估，以确定并减少影响治疗依从性和反应的社会和环境障碍。老年护理人员与老年保健合作伙伴一起为他们共同的病人制定多学科护理计划，加强治疗依从性和采取健康行为，并强调老年人积极参与旨在改善他们与他人和社区联系的活动。最后，PCP、AW和精神科顾问接受培训，在他们共同的客户护理中进行合作。160个村庄将被随机分配给居住在那里的符合条件的受试者（每个村庄约15人符合标准），或总共约2400名受试者。治疗将持续一年，在基线、3、6、9和12个月进行研究评估。利用数据将从电子病历和管理记录中获得。该研究的具体目的是确定COACH在治疗抑郁症（目的1）和HTN（目的2）方面是否比CAU更有效；治疗依从性的改善是否先于抑郁症状的减少和血压控制的改善（Aim 3a），以及抑郁症状的改善是否先于血压控制的改善（Aim 3b）；如果COACH比CAU更能改善健康相关的生活质量（目的4）；并比较与每种方法相关的成本（目标5）。

DESCRIPTION (provided by applicant): The Depression/Hypertension in Chinese Older Adults - Collaborations in Health (COACH) Study is a randomized controlled trial (RCT) comparing the COACH intervention to CAU for the treatment of comorbid depression and HTN in Chinese older adult rural village residents. COACH integrates the care provided by the older person's primary care provider (PCP) with that delivered by an Aging Worker (AW; a lay member of the village's Aging Association), supervised by a psychiatrist consultant. Based on chronic disease management principles, the PCP is trained to use evidence based practice guidelines for treatment of both HTN and depression, and provided with access to mental health consultation regarding optimal management of the patient's depression. The AW is trained to conduct a systematic assessment of the older person's social context to identify and reduce social and environmental barriers to treatment adherence and response. AWs participate with the PCP in developing multi-disciplinary care plans for their shared patients, reinforce treatment adherence and adoption of healthy behaviors, and emphasize activation and engagement of the older person in activities designed to improve their connectedness to others and to the community. Finally, PCP, AW, and Psychiatrist Consultant are trained to collaborate in their shared clients' care. 160 villages will be randomized to deliver COACH or CAU to eligible subjects who reside there (approximately 15 per village will meet criteria), or a total of about 2400 subjects. Treatment will continue for one year, with research evaluations at baseline, 3 6, 9, and 12 months. Utilization data will be obtained from the EMR and administrative records. Specific aims of the study are to determine whether COACH is more effective than CAU in treating depression (Aim 1) and HTN (Aim 2); whether improvements in treatment adherence precede reductions in depression and improvement in BP control (Aim 3a), and whether improvements in depression symptoms precede improvements in BP control (Aim 3b); if COACH is associated with greater improvements in health- related quality of life than CAU (Aim 4); and to compare the costs associated with each approach (Aim 5).