MUPS in Primary Care Research Center

描述（由申请人提供）：这是根据 PAR 01-090 为干预和服务研究发展中心 (DCISR) 提供资助的请求。这个新中心将重点关注在初级保健中出现医学无法解释的身体症状（MUPS）的患者。 MUPS（例如不明原因的疼痛、麻木、胃肠道症状）是初级保健机构中一种非常常见的致残性精神疾病的临床表现，例如抑郁和焦虑。这个新开发中心的名称将是“MUPS 初级保健研究中心”(MUPS-PCRC)。该中心将建立必要的核心（例如运营、方法、培训）和基础设施，以开发针对该人群的初级保健创新服务研究项目。此外，计划针对 MUPS-PCRS 的初步研究将涉及社会经济地位较低的拉丁裔和非裔美国患者，因为这些人群在精神卫生保健方面存在有据可查的差异。 MUPS-PCRS 的教员还将探索具有文化能力的协作阶梯式护理模式用于治疗 MUPS 初级保健患者的有效性，同时研究患者、家庭成员、医生和行为健康护理专家如何接受该模式。 与领先研究人员组成的外部咨询委员会协商后，计划至少进行四项试点研究，并加快研究基础设施的实施。这些研究将收集协作阶梯护理模式不同阶段的初步数据。一项研究将重点关注模型第一阶段使用的专门视频和其他教育材料的开发和测试，而另一项研究将重点关注认知行为疗法（CBT）作为第二阶段治疗策略和促进行为健康护理转诊的一种方式的有效性。另外两项研究涉及对 CBT 反应不佳的患者的替代第三阶段治疗：a) 心率变异性生物反馈用于治疗残余抑郁和躯体不适； b) 人际关系治疗。我们期望，在中心运营的最初几年中进行的各种研究中收集的初步数据将为 MUPS-PCRC 教职人员和学员发起的几项更大规模的研究者发起的资助申请的设计和规划提供信息。

DESCRIPTION (provided by applicant): This is a request for funding a Developing Center for Intervention and Services Research (DCISR) in response to PAR 01-090. This new center will focus on patients who present in primary care with medically unexplained physical symptoms (MUPS). MUPS (e.g., unexplained pain, numbness, gastrointestinal symptoms) comprise a very common clinical presentation for disabling psychiatric disorders in primary care settings, such as depression and anxiety. The name of this new Developing Center will be the "MUPS in Primary Care Research Center" (MUPS-PCRC.) The center will build the necessary cores (e.g., operations, methods, training) and infrastructure for developing an innovative services research program in primary care concerning this population. Furthermore, the initial studies planned for the MUPS-PCRS will relate to lower socioeconomic status Latino and African-American patients, due to the well-documented disparities in mental health care for these populations. The faculty of MUPS-PCRS will also explore the effectiveness of a culturally- competent, collaborative stepped-care model for treating primary care patients with MUPS, while examining how patients, family members, physicians and behavioral health care specialists accept this model. At least four pilot studies are planned, in consultation with an external advisory board of leading researchers, and apace with research infrastructure implementation. These studies will gather preliminary data on different stages of the collaborative stepped-care model. One study will focus on development and testing of specialized videos and other educational materials to be used in the first stage of the model, whereas another study will focus on the effectiveness of cognitive behavioral therapy (CBT) as a second stage treatment strategy and as a way to facilitate behavioral health care referrals. Two other studies concern alternative third-stage treatments for patients who do not respond well to CBT: a) heart rate variability biofeedback for the treatment of residual depression and somatic complaints; b) interpersonal therapy. The expectation is that preliminary data collected in the various studies conducted in the first few years of Center operations will inform the design and planning of several larger-scale investigator -initiated grant applications from MUPS-PCRC faculty and trainees.