Telemonitoring Enhanced Support for Depression Self Management

远程监控增强对抑郁症自我管理的支持

• 批准号: 9079060
• 负责人: James E Aikens
• 金额: $ 15.27万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-09-18 至 2016-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9079060
• 关键词: Abbreviations; Acute; Address; Adult; Antidepressant adherence; Area; Behavior monitoring; Caregivers; Caring; Case Manager; Cells; Child; Chronic; Clinic; Clinical; Community Health; Community Practice; Computers; Depressed mood; Disease remission; Economically Deprived Population; Effectiveness; Electronic Mail; Event; Exhibits; Eye; Family member; Federally Qualified Health Center; Feedback; Friends; Health; Health Benefit; Health Care Costs; Helping Behavior; Home environment; Household; Impairment; Internet; Intervention; Interview; Life; Link; Low income; Mental Depression; Mental disorders; Methods; Monitor; Moods; Outcome; Participant; Patient Monitoring; Patients; Personal Satisfaction; Persons; Primary Health Care; Public Health; Reporting; Research; Research Infrastructure; Risk; Rural Health Centers; Self Care; Self Management; Services; Severities; Social Network; Social isolation; Specific qualifier value; Spouses; System; Technology; Telefacsimile; Telephone; Testing; Time; Training; Treatment Efficacy; Underinsured; Update; Visit; Voice; Work; base; burnout; care giving burden; compare effectiveness; cost; depressed patient; depressive symptoms; design; follow-up; functional disability; improved; innovation; medically underserved; medically underserved population; member; primary outcome; response; satisfaction; secondary outcome; social; therapy development; tool; treatment as usual; uptake

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.

描述（由申请人提供）：虽然抑郁症护理管理改善了结果，但其广泛采用受到基础设施，报销和干预时间的限制。因此，护理经理往往无法提供时间密集的支持，许多抑郁症患者需要，以实现最佳的结果。虽然这一服务差距可以通过家庭护理人员的支持部分弥补，但家庭护理人员缺乏有效监测患者临床需求和支持其自我管理的正式工具。ICG也面临着照顾者倦怠的风险，这是由于竞争性需求和社会孤立。最后，许多患者没有ICG。 我们建议解决这些问题的实际干预，使用低成本的技术来激活抑郁症患者现有的社交网络的自我管理支持，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成员或亲密朋友。通过每周自动远程监测，患者报告他们的情绪和自我管理状态，并接受量身定制的自我管理指导。CP会收到相应的更新沿着关于如何最好地支持患者自我管理工作的指导，并将临床紧急情况通知初级护理团队。我们的试点工作证明了干预的可行性和潜在的有效性，使患者始终从事远程监护，CP和临床医生的报告被成功地发出，抑郁症状显着减少。 我们现在计划严格评估干预措施在为低收入和保险不足的患者提供服务的诊所的抑郁症初级保健患者中的疗效，干预措施特别旨在使这些患者受益。具体目标1是进行一项随机对照试验，以比较一年远程监护支持的CP治疗抑郁症与常规护理（对照）对抑郁症严重程度的有效性。具体目标2是检查关键的次要结局（反应和缓解、损伤、幸福感、生活负担、医疗费用）和潜在的调节因素。具体目标3是使用混合方法的方法，以丰富我们的统计协会的解释，并发现策略，以提高干预的可接受性，有效性和可持续性。如果干预措施被证明是有效的，而不增加临床医生的负担或边际成本，那么它的后续实施可能会产生重大的公共卫生效益，特别是在医疗服务不足的人群。社会效益也可以通过促进帮助行为和社会关系来实现。后续研究可以实施干预措施，并将其重点扩展到特定的抑郁症亚型以及其他慢性精神疾病。 在这个重新提交的提案中，我们通过向我们的团队增加专业专家，加强我们的参与者保护，并提供更多的方法细节来回应评审员的反馈。