The Depression/Hyptertension COACH Study - supplement

描述(申请人提供)：中国老年抑郁症/高血压-健康合作(COACH)研究是一项随机对照试验(RCT)，比较了CORT干预和CAU对中国农村老年居民并发抑郁症和HTN的治疗。Coach将老年人的初级护理提供者(PCP)提供的护理与老年工作者(AW；该村老龄协会的非专业成员)提供的护理相结合，并由精神科顾问进行监督。根据慢性病管理原则，PCP接受培训，使用循证实践指南治疗HTN和抑郁症，并为患者提供关于最佳抑郁症管理的心理健康咨询。妇女福利会接受培训，对老年人的社会环境进行系统评估，以确定和减少治疗、坚持和应对方面的社会和环境障碍。AWS与PCP一起为他们共享的患者制定多学科护理计划，加强对治疗的坚持和健康行为的采用，并强调老年人积极参与旨在改善他们与他人和社区的联系的活动。最后，PCP、AW和精神病学家顾问接受培训，以便在他们共同护理客户的过程中进行协作。160个村庄将被随机分配给居住在那里的合格受试者(每个村庄大约15个符合条件的受试者)，或者说总共大约2400个受试者。治疗将持续一年，研究评估分别为基线、3个月、6个月、9个月和12个月。使用率数据将从电子病历和行政记录中获得。这项研究的具体目的是确定在治疗抑郁症(目标1)和HTN(目标2)方面，教练是否比CAU更有效；治疗依从性的改善是否先于抑郁症的减少和血压控制的改善(目标3a)，以及抑郁症状的改善是否先于血压控制的改善(目标3b)；教练是否比CAU(目标4)更能改善与健康相关的生活质量；以及比较每种方法的相关成本(目标5)。

DESCRIPTION (provided by applicant): The Depression/Hypertension in Chinese Older Adults - Collaborations in Health (COACH) Study is a randomized controlled trial (RCT) comparing the COACH intervention to CAU for the treatment of comorbid depression and HTN in Chinese older adult rural village residents. COACH integrates the care provided by the older person's primary care provider (PCP) with that delivered by an Aging Worker (AW; a lay member of the village's Aging Association), supervised by a psychiatrist consultant. Based on chronic disease management principles, the PCP is trained to use evidence based practice guidelines for treatment of both HTN and depression, and provided with access to mental health consultation regarding optimal management of the patient's depression. The AW is trained to conduct a systematic assessment of the older person's social context to identify and reduce social and environmental barriers to treatment adherence and response. AWs participate with the PCP in developing multi-disciplinary care plans for their shared patients, reinforce treatment adherence and adoption of healthy behaviors, and emphasize activation and engagement of the older person in activities designed to improve their connectedness to others and to the community. Finally, PCP, AW, and Psychiatrist Consultant are trained to collaborate in their shared clients' care. 160 villages will be randomized to deliver COACH or CAU to eligible subjects who reside there (approximately 15 per village will meet criteria), or a total of about 2400 subjects. Treatment will continue for one year, with research evaluations at baseline, 3 6, 9, and 12 months. Utilization data will be obtained from the EMR and administrative records. Specific aims of the study are to determine whether COACH is more effective than CAU in treating depression (Aim 1) and HTN (Aim 2); whether improvements in treatment adherence precede reductions in depression and improvement in BP control (Aim 3a), and whether improvements in depression symptoms precede improvements in BP control (Aim 3b); if COACH is associated with greater improvements in health- related quality of life than CAU (Aim 4); and to compare the costs associated with each approach (Aim 5).