Understanding Social Contributions to Disparities in Depression Care: US and UK

了解社会对抑郁症护理差异的贡献：美国和英国

• 批准号: 7916369
• 负责人: Debra L Roter
• 金额: $ 12.3万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-08-17 至 2014-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7916369
• 关键词: Accounting; Achievement; Address; Affect; Affective; Age; Alcohol consumption; Caring; Characteristics; Clinical; Cognitive; Communication; Competence; Data; Databases; Depressed mood; Depression and Suicide; Dimensions; Ethnic Origin; Feeling suicidal; Female; Future; Gender; Habits; Health Services Research; Health system; Healthcare; Healthcare Systems; Illicit Drugs; Indium; Institute of Medicine (U.S.); Intervention; Investigation; Judgment; Life Style; Light; Medical; Medical Education; Mental Depression; Mental Health; Minority Groups; Modeling; Nature; Outcome; Participant; Patient Education; Patients; Perception; Personal Communication; Pharmaceutical Preparations; Physicians; Play; Primary Health Care; Process; Race; Reaction; Recommendation; Recruitment Activity; Reporting; Research; Research Design; Risk Assessment; Role; Shapes; Simulate; Smoking; Source; Structure; Testing; Thinking; Training; Trust; Videotape; Visit; analog; care delivery; cultural competence; depressive symptoms; design; drinking; effective intervention; empowerment; expectation; health care delivery; health disparity; insight; literacy; male; meetings; novel strategies; programs; public health relevance; reaction rate; response; satisfaction; simulation; skills; social; suicidal risk; willingness

DESCRIPTION (provided by applicant): Physicians' ability to communicate effectively with patients from ethnically and socially diverse backgrounds is essential to reducing health disparities. However, communication is not solely the task of medical professionals, patients also play a critical role in active participation in their care and in gaining the necessary confidence and competence to implement and continue treatment. The disparities that are evident within medical care reflect the interplay of social factors, including race, gender, age, literacy, and the cultural and normative expectations that guide the perspectives of both patients and physicians. The proposed investigation is designed to contribute to the disentangling of physician-derived and patient-derived contributions to social bias that may exacerbate health disparities associated with the provision and receipt of depression care and suicide risk assessment in the US and UK. In order to do so, we propose a novel approach in which videotape simulations are used to portray a depression -focused visit in primary care in which the ethnicity and gender of the participants have been experimentally manipulated. While sharing the context of a medical visit, the simulations differ in focus; one is designed to examine physicians' cognitive and clinical reasoning processes while the other explores patients' perceptions, responses and judgments related to the receipt of care. In the first study (for which data are already collected), visit simulations were shown to 128 US and UK physicians who were asked to take the role of the treating physician and provide a narrative account of their clinical reasoning. The second study shows simulated depression visits, in which patient and physician gender and ethnicity is experimentally manipulated, to 640 ethnically diverse male and female subjects in the US and UK. Subjects vicariously take the role of the depressed patient in the simulations to provide insights into their cognitive and affective reactions to care. In this way, we will be able to explore how subjects acting as analogue patients and physicians are influenced by gender and ethnicity in making medical care judgments in the context of the US and UK health care system and social structure. Study 3 will test the ecological validity of the analogue findings through the analysis of actual patient data in which physicians from different ethnic backgrounds have assessed patients' depression and suicide risk in an anonymised database. PUBLIC HEALTH RELEVANCE: ability to communicate effectively with patients from ethnically and socially diverse backgrounds is essential to reducing health disparities. However amelioration of disparities is not solely the task of medical professionals: patients also play a critical role in active participation in care and acquisition of the confidence and competence necessary to implement and continue treatment. The proposed investigation is designed to contribute to the disentangling of physician-derived and patient-derived contributions to social bias that may exacerbate health disparities associated with the provision and receipt of depression care and suicide risk in the US and UK so that more effective interventions may be designed and implemented.

描述（由申请人提供）：医生与来自种族和社会背景的患者有效沟通的能力对于降低健康差异至关重要。但是，沟通不仅是医疗专业人员的任务，患者在积极参与护理以及获得实施和继续治疗的必要信心和能力方面也起着至关重要的作用。医疗保健中明显的差异反映了社会因素的相互作用，包括种族，性别，年龄，识字以及指导患者和医生的观点的文化和规范期望。拟议的调查旨在促进医师衍生和患者衍生的社会偏见贡献的贡献，这可能会加剧与美国和英国的抑郁症护理和自杀风险评估相关的健康差异。为了做到这一点，我们提出了一种新颖的方法，其中使用录像带模拟来描绘抑郁症的初级保健访问，其中参与者的种族和性别已通过实验操纵。在分享医疗访问的背景下，模拟的重点不同。一个人旨在检查医师的认知和临床推理过程，而其他人则探讨了患者的看法，反应和判断与接受护理有关的判断。在第一项研究（已经收集了数据）中，向128位美国和英国医生展示了访问模拟，他们被要求扮演治疗医师的角色，并提供有关其临床推理的叙述。第二项研究表明，在美国和英国，对患者和医师的性别和种族进行了实验操纵，对患者和医师的性别和种族进行了操纵，在该抑郁症访问中进行了操纵。受试者在模拟中扮演抑郁症患者的角色，以洞悉其对护理的认知和情感反应。通过这种方式，我们将能够探索在美国和英国卫生保健系统以及社会结构的背景下，在做出医疗判断时，以性别和种族判断时，作为模拟患者和医生的受试者如何受到性别和种族的影响。研究3将通过分析实际患者数据来测试模拟发现的生态有效性，其中来自不同种族背景的医生在匿名数据库中评估了患者的抑郁症和自杀风险。公共卫生相关性：与来自种族和社会背景的患者有效沟通的能力对于降低健康差异至关重要。但是，对差异的改善并不仅仅是医疗专业人员的任务：患者在积极参与护理和获得实施和继续治疗所必需的信心和能力方面也起着至关重要的作用。拟议的调查旨在促进对社会偏见的医师衍生和患者衍生的贡献的贡献，这可能会加剧与美国和英国的抑郁症护理和自杀风险相关的健康差异，以便可以设计和实施更有效的干预措施。