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Equity in Depression Care for Primary Care Patients with Language Barriers

对有语言障碍的初级保健患者的抑郁症护理的公平性

基本信息

批准号：
10651617
负责人：
Maria Esteli Garcia
金额：
$ 17.21万
依托单位：
UNIVERSITY OF CALIFORNIA, SAN FRANCISCO
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-08-01 至 2025-03-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10651617
关键词：
Address Adoption Antidepressive Agents Area Asian population Award Behavioral California Caring Chinese Chronic Disease Clinic Clinical Communication Country Custom Data Decision Making Depression screen Diagnosis Disclosure Discourse analysis Disease Outcome Disease remission Disparity Education Electronic Health Record Ensure Equity Experimental Designs Face Fostering Foundations Funding Future Genetic Transcription Goals Health Health Disparities Research Health Services Health system Healthcare Healthcare Systems Individual Internist Intervention Interview K-Series Research Career Programs Knowledge Language Latino Latino Population Limited English Proficiency Linguistics Mental Depression Mental Health Mentors Mentorship Methods Morbidity - disease rate National Institute on Minority Health and Health Disparities Outcome Patient Care Patients Pattern Pharmaceutical Preparations Phase Physicians Population Primary Care Primary Health Care Provider Quality of life Reduce health disparities Research Research Personnel Research Priority Review Literature Risk San Francisco Structure Summary Reports Surveys System Testing Training United States care delivery career cohort demographics depressive symptoms design disability disparity reduction empowerment evidence base experience follow-up health disparity implementation evaluation implementation science improved intervention refinement mortality mortality risk novel patient engagement patient oriented patient-clinician communication preference primary care patient primary care practice primary care provider primary care setting primary care visit prototype screening shared decision making skills stakeholder perspectives systematic review theories therapy design therapy development tool

项目摘要

Project Summary Depression is a leading cause of disability in the United States. Patients with limited English proficiency (LEP), particularly Asians and Latinos, who represent the largest demographics with LEP in the country, are at increased risk of poor provider recognition of depressive symptoms and under-treatment of depression. Universal depression screening in primary care, with a focus on initial depression treatment, may be a way to systematically identify patients with LEP who could benefit from treatment. However, barriers to depression care are likely multifactorial and are still poorly understood. The objective of this application is to understand whether universal approaches to depression screening and initial care for depression are equally effective for all groups, or whether targeted efforts are needed to increase depression screening, diagnosis and treatment in primary care among patients with LEP. Within the context of a primary care setting, the specific aims are to (1) evaluate differences in depression screening and initial treatment by patient preferred language after adoption of annual universal depression screening, (2) examine patterns of patient-provider communication about depressive symptoms, and (3) to involve key stakeholders to develop a patient- and provider-facing, practice-based intervention prototype to improve annual depression screening, elicit patient concerns and treatment preferences, foster improved communication and patient empowerment about initial treatment, and increase engagement in depression care. These aims will be achieved using mixed methods and health disparities research frameworks, and they address the NIMHD research priority areas of developing healthcare interventions to reduce health disparities and to improve patient-clinician communication and shared-decision making. The studies are novel in their focus on the mental health needs of primary care patients with LEP as well as the proposed use of mixed methods to develop a theory-driven intervention prototype. The proposed studies are informed by Dr. Maria Esteli Garcia’s experience as an internist working in diverse, urban primary care settings. Dr. Garcia’s long- term career goal is to improve depression care for patients with LEP in primary care. During the course of this award, Dr. Garcia will undertake didactic and experiential training to improve knowledge and skills in three areas: (1) mixed methods, (2) evidence-based depression care, and (3) experimental designs for use in real world settings. Dr. Garcia has assembled a mentorship team with expertise in mixed methods, health services and implementation science research, evidence-based depression treatment, and intervention design to ensure completion of the proposed research and training and successful transition to independence. Ultimately, these projects are expected to provide the foundation for future R34 and R01 applications and further refinement of an intervention to reduce mental health disparities by improving depression screening and initial depression care for patients with LEP.

项目摘要抑郁症是美国残疾的主要原因。英语水平有限（LEP）的患者，特别是亚洲人和拉丁美洲人，他们代表了该国最大的LEP人口，抑郁症状和抑郁症治疗不足的不良提供者识别的风险增加。在初级保健中进行普遍的抑郁症筛查，重点是最初的抑郁症治疗，可能是一种方法，系统地确定LEP患者谁可以从治疗中受益。然而，抑郁症的障碍护理可能是多因素的，而且人们仍然对它知之甚少。本申请的目的是了解抑郁症筛查和抑郁症初始护理的通用方法是否对所有群体，或者是否需要有针对性的努力，以增加抑郁症的筛查，诊断和治疗在LEP患者的初级保健中。在初级保健环境中，具体目标是 (1)评估抑郁症筛查和患者首选语言的初始治疗的差异，采用年度普遍抑郁症筛查，（2）检查患者-提供者沟通模式关于抑郁症状，以及（3）让关键利益相关者参与制定一个面向患者和提供者的，基于实践的干预原型，以改善年度抑郁症筛查，引起患者的关注，治疗偏好，促进改善沟通和患者对初始治疗的授权，以及增加对抑郁症护理的参与。这些目标将通过混合方法和健康差异研究框架来实现，解决NIMHD研究的优先领域，制定医疗保健干预措施，以减少健康差距并改善患者-临床医生沟通和共同决策。这些研究在其重点关注LEP初级保健患者的心理健康需求，以及建议使用混合开发理论驱动的干预原型的方法。拟议的研究由Maria博士告知埃斯特利加西亚的经验，作为一个内科医生在不同的工作，城市初级保健设置。加西亚医生很久- 长期职业目标是改善初级保健中LEP患者的抑郁症护理。在此过程中，奖，加西亚博士将进行教学和体验培训，以提高知识和技能，在三个领域：（1）混合方法，（2）基于证据的抑郁症护理，（3）用于真实的实验设计世界设置。加西亚博士组建了一个导师团队，他们在混合方法，医疗服务，和实施科学研究，循证抑郁症治疗和干预设计，确保完成拟议的研究和培训，并成功过渡到独立。最终，这些项目有望为未来的R34和R 01应用奠定基础，进一步完善干预措施，通过改善抑郁症筛查减少心理健康差距， LEP患者抑郁症初期护理