Targeting Treatment Resistant Depression in Primary Care

描述（由申请人提供）：本指导的目标 以患者为导向的研究职业发展奖（K23）是为了让 申请人（1）获得进行研究所需的知识基础 分析初始抗抑郁药后无应答的模式 在初级保健机构的干预，（2）使用这些信息， 准确定位那些在初级治疗中适当观察到的无应答患者， 护理机构进行预防性心理社会干预。五年奖 将允许申请人完善他在临床流行病学的研究技能 和卫生服务研究，并将其应用于临床 有效性试验。这项研究的目的是减少 初级保健中抑郁症的持续性、复发性和失能 设置.职业发展计划提出了课程，实用和 指导研究活动，以支持三个核心领域的学习：临床 流行病学，生物统计学和卫生服务研究;认知行为 初级保健环境中的CBT治疗;和临床有效性试验 设计在初级保健设置。项目1将是以下项目的二次数据分析 一个前瞻性的、纵向的公共部门初级保健数据集，以1）确定 可以预测反应类别的治疗前特征 在充分的抗抑郁药试验后，2）确定时间点 在治疗开始后，当那些尚未完全缓解的患者 不太可能在经过充分的审判后这样做。这样的分析将使我们 为了更好地理解对初始 抗抑郁药物干预，这将有助于我们更好地了解 通过确定与预处理相关的关键因素， 特色根据上述分析结果，项目2将测试 进行多中心随机临床试验的可行性 评估有针对性的连续性CBT干预的有效性的护理， 它将测试应用所确定的预处理措施的可行性 在项目1中预测对标准药物管理的反应水平。 该项目将提供初步数据，并指导后续的设计 多中心R-01申请，将在第3年提交。五 一年K23奖将使申请人获得所需的研究技能 成为一名独立的研究者，能够将临床研究 流行病学和护理质量的优势，实践研究和 基于人群的临床相关有效性研究优势 干预研究。申请人的职业生涯将致力于发展一个 一项研究计划，重点是帮助初级保健临床医生的目标治疗 为顽固性抑郁症患者提供经济有效的治疗方法 心理社会干预。

DESCRIPTION (provided by applicant): The goals of this Mentored Patient-Oriented Research Career Development Award (K23) are to allow the applicant (1) to acquire the knowledge base necessary to conduct research analyzing patterns of non-response following an initial antidepressant intervention in primary care settings, and (2) to use this information to accurately target those nonresponding patients appropriately seen in primary care settings for adjunctive psychosocial interventions. The five-year award will allow the applicant to refine his research skills in clinical epidemiology and health services research and to apply them toward the conduct of clinical effectiveness trials. The aim of this line of research is to decrease the persistence, recurrence and disability of depressive illness in primary care settings. The career development plan proposes coursework, practical and mentored research activities to support learning in three core areas: clinical epidemiology, biostatistics, and health services research; cognitive-behavioral treatment (CBT) in primary care settings; and clinical effectiveness trials design in primary care settings. Project 1 will be a secondary data analysis of a prospective, longitudinal public sector primary care data set to 1) identify pre-treatment characteristics which can predict categories of response following an adequate antidepressant trial, and 2) identify the time point after treatment initiation when those patients who have yet to fully respond are unlikely to do so after an adequate trial. Such an analysis will allow us to better understand the various patterns of response to an initial antidepressant intervention, and it will help us to better understand the causes of non-response by identifying key related pre-treatment characteristics. Based on results of the above analysis, Project 2 will test the feasibility of conducting a multi-site randomized clinical trial in primary care that assesses the effectiveness of a targeted adjunctive CBT intervention, and it will test the feasibility of applying pre-treatment measures identified in Project 1 to predict levels of response to standard medication management. This project will provide preliminary data and guide the design of a subsequent multi-site R-01 application, whose submission will occur in year 3. The five year K23 award will enable the applicant to obtain the research skills required to become an independent investigator able to translate both the clinical epidemiologic and quality of care strengths of practice research and the population-based strengths of effectiveness research into clinically relevant interventions research. The applicant's career will be devoted to developing a program of research focused on helping primary care clinicians target treatment resistant depressed patients for the provision of cost-effective adjunctive psychosocial interventions.