Dissemination of Computer-assisted Cognitive-behavior Therapy for Depression in Primary Care

 描述（由申请人提供）：将在一项试验中评估在初级保健中传播计算机辅助认知行为疗法（CCBT）治疗抑郁症的效果，该试验将320名患者随机分配到CCBT或常规治疗（TAU）组。这项研究将传播一种在精神病环境中有效的治疗方法到初级保健-一种在提供充分的循证抑郁症治疗方面存在重大问题的环境。这项研究将包括高比例的弱势患者-这一人群在以前的CCBT研究中基本上被忽视了。以前没有在初级保健中进行CCBT治疗抑郁症的研究，这些研究招募了大量弱势患者。本研究中使用的CCBT形式旨在增加获得有效治疗的机会，提供具有成本效益的方法，并成为在初级保健中广泛使用的可持续模式。 为了以一种可以在其他初级保健实践中复制的实用方式提供治疗，具有显著抑郁症状的患者将接受经验支持的计算机程序的治疗，该程序建立认知行为治疗技能。CCBT的支持将通过电话和/或电子邮件与护理协调员联系提供，而不是与认知行为治疗师面对面的治疗，这是CCBT在心理健康环境中提供的一部分。该治疗方案的新特点包括：1）在初级保健中将临床医生支持与CCBT相结合的完全详细和可复制的方法; 2）向弱势患者比例较高的人群提供CCBT; 3）将CCBT整合到初级保健提供模式中; 4）高度互动的多媒体计算机程序，适用于教育或计算机经验较低的人群; 5）先进的成本效益分析，包括实际的卫生保健利用和成本的数据; 6）探讨调节和预测治疗结果。 将通过测量CCBT完成率、对CBT概念的理解和对治疗的满意度来评估结果;此外还将评估抑郁症状、消极想法和生活质量。成本效益分析和可能的预测结果的探索应有助于临床医生，卫生保健组织和其他计划进一步传播CCBT在初级保健。

 DESCRIPTION (provided by applicant): Dissemination of Computer-assisted cognitive-behavior therapy (CCBT) for depression in primary care will be evaluated in a trial with 320 patients randomly assigned to CCBT or treatment as usual (TAU). The study will disseminate a therapy method found to be effective in psychiatric settings into primary care - a setting where there have been significant problems in delivery of adequate, evidence-based treatment for depression. The study will include a high percentage of disadvantaged patients - a population that has been largely ignored in previous research in CCBT. There have been no previous studies of CCBT for depression in primary care that have enrolled large numbers of disadvantaged patients. The form of CCBT used in this study is designed to increase access to effective therapy, provide a cost-effective method, and be a sustainable model for wide-spread use in primary care. In order to deliver therapy in a practical manner that can be replicated in other primary care practices, patients with significant symptoms of depression will receive treatment with an empirically supported computer program that builds cognitive-behavior therapy skills. Support for CCBT will be provided by telephone and/or e-mail contact with a care coordinator instead of the face-to-face treatment with a cognitive-behavior therapist that has been a part of CCBT delivery in mental health settings. Novel features of this treatment program include: 1) fully detailed and replicable method for integrating clinician support with CCBT in primary care; 2) delivery of CCBT to a population with high percentage of disadvantaged patients; 3) integration of CCBT into the primary care delivery model; 4) highly interactive, multimedia computer program with adaptations for persons who may have lower levels of education or computer experience; 5) advanced cost-benefit analysis including data on actual health care utilization and costs; 6) exploration of moderators and predictors of treatment outcome. Outcome will be assessed by measuring CCBT completion rate, comprehension of CBT concepts, and satisfaction with treatment; in addition to ratings of depressive symptoms, negative thoughts, and quality of life. The cost-effectiveness analysis and exploration of possible predictors of outcome should help clinicians, health care organizations, and others plan further dissemination of CCBT in primary care.