Rapid Access to Perinatal Psychiatric Care in Depression Program (RAPPID): An Innovative Stepped-Care Approach for Obstetrics and Gynecology Clinics

 描述(由申请人提供)：这份U01提案的主要目标是完善、评估和传播一种新的低成本和可持续的妇产科(Ob/gyn)诊所分级护理计划，该计划将提高围产期妇女的治疗率和结果。这项研究具有巨大的公共卫生需求，因为抑郁症是全世界育龄妇女残疾的主要原因。超过五分之一的女性患有围产期抑郁症。它对出生结果、婴儿依恋和儿童的行为/发育都有有害的影响。抑郁症妇女产后死亡中有20%是由产妇自杀引起的。尽管绝大多数围产期妇女都愿意接受抑郁症筛查，但仅靠筛查并不能改善治疗率或患者结局。妇产科诊所需要适当的支持，以充分解决患者群体中的抑郁问题。因此，我们开发并试行了抑郁症围产期精神护理快速获取(RAPPID)计划，以创建一种积极、多方面和实用的综合干预措施。RAPPID旨在通过以下方式提高围产期抑郁症的治疗和治疗响应率：(1)为妇产科提供者提供即时资源/转介和精神科电话咨询；(2)针对诊所实施分级护理，包括培训支持和工具包；以及(3)积极主动的治疗参与、患者监测和对抑郁症筛查/评估的阶段性治疗反应。RAPPID建立在我们团队开发的低成本和广泛传播的基于人群的模式基础上，在初级保健环境中提供精神护理。形成的数据和主要利益攸关方的反馈也为RAPPID的发展提供了信息。我们在现实世界环境中的试点工作表明，RAPPID是可行的，并改进了妇产科环境中的抑郁症检测和治疗。由于它使用现有的基础设施和资源，RAPPID有可能是可行的、可持续的，并可转移到其他实践环境。我们建议在一项整群随机试验中比较两种积极的干预措施，RAPPID和增强型常规护理(获得资源提供/转诊和精神科电话咨询)，在该试验中，我们将随机选择12家妇产科诊所进行RAPPID或增强型常规护理。我们将在300名患者(n=150人/组，25人/诊所)产后12个月内比较RAPPID和增强的常规护理在改善抑郁严重程度和怀孕期间治疗参与度方面的有效性。然后，我们将通过多层面传播战略传播调查结果和建议，以促进各国的了解。我们与利益攸关方建立的关系促进了RAPPID的广泛传播和实施的潜力。我们在产科和抑郁症护理、整群随机试验和妇产科方面的综合专业知识使我们非常适合实施、测试和广泛传播RAPPID。如果被证明有效，RAPPID将准备在全国推广。

 DESCRIPTION (provided by applicant): The primary goal of this U01 proposal is to refine, evaluate, and disseminate a new low-cost and sustainable stepped care program for Obstetrics/Gynecology (Ob/Gyn) clinics that will improve perinatal women's treatment rates and outcomes. There is a tremendous public health need for this research as depression is the leading cause of disability among women of reproductive age worldwide. Upwards of 1 in 5 women suffer from perinatal depression. It has deleterious effects on birth outcomes, infant attachment, and children's behavior/development. Maternal suicide causes 20% of postpartum deaths in depressed women. Although the vast majority of perinatal women are amenable to being screened for depression, screening alone does not improve treatment rates or patient outcomes. Ob/Gyn clinics need supports in place to adequately address depression in their patient populations. Thus, we developed and pilot tested the Rapid Access to Perinatal Psychiatric Care in Depression (RAPPID) Program, to create a comprehensive intervention that is proactive, multifaceted, and practical. RAPPID aims to improve perinatal depression treatment and treatment response rates through: (1) access to immediate resource provision/referrals and psychiatric telephone consultation for Ob/Gyn providers; (2) clinic-specific implementation of stepped care, including training support and toolkits; and, (3) proactive treatment engagement, patient monitoring, and stepped treatment response to depression screening/assessment. RAPPID builds on a low-cost and widely disseminated population-based model for delivering psychiatric care in primary care settings developed by our team. Formative data and feedback from key stakeholders also informed the development of RAPPID. Our pilot work in real-world settings suggests RAPPID is feasible and improves depression detection and treatment in Ob/Gyn settings. Because it uses existing infrastructure and resources, RAPPID, has the potential to be feasible, sustainable and transportable to other practice settings. We propose to compare two active interventions, RAPPID vs. enhanced usual care (access to resource provision/referrals and psychiatric telephone consultation) in a cluster-randomized trial in which we will randomize 12 Ob/Gyn clinics to either RAPPID or enhanced usual care. We will compare the effectiveness of RAPPID vs. enhanced usual care to improve depression severity and treatment participation in pregnancy through 12 months postpartum among 300 patients (n=150/group, 25/clinic). We will then disseminate findings and recommendations via a multi-dimensional dissemination strategy to facilitate national uptake. Our established relationships with stakeholders boosts the potential for widespread dissemination and implementation of RAPPID. Our combined expertise in the integration of obstetric and depression care, cluster-randomized trials and Ob/Gyn make us ideally suited to implement, test and widely disseminate RAPPID. If proven effective, RAPPID will be poised for national dissemination.