The Depression Hypertension COACH Study

描述（由申请人提供）：中国老年人抑郁/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 对中国农村老年人共病抑郁和高血压的治疗效果。 COACH 将老年人的初级保健提供者 (PCP) 提供的护理与老年工作者（AW；村老龄协会的非专业成员）提供的护理结合起来，并由精神科顾问监督。根据慢性病管理原则，PCP 接受培训，使用基于证据的实践指南来治疗高血压和抑郁症，并获得有关患者抑郁症最佳管理的心理健康咨询。老年妇女接受过培训，可以对老年人的社会背景进行系统评估，以识别和减少对治疗依从性和反应的社会和环境障碍。 AW 与 PCP 一起为其共同患者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其与他人和社区联系的活动。最后，PCP、AW 和精神科医生顾问接受过培训，可以在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合格受试者（每个村庄大约 15 名受试者符合标准），即总共约 2400 名受试者。治疗将持续一年，并在基线、第 3、6、9 和 12 个月进行研究评估。使用数据将从 EMR 和管理记录中获取。该研究的具体目的是确定 COACH 在治疗抑郁症（目标 1）和高血压（目标 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的减少和血压控制的改善（目标 3a），以及抑郁症状的改善是否先于血压控制的改善（目标 3b）； COACH 是否比 CAU 更能改善健康相关的生活质量（目标 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).