Targeting Treatment Resistant Depression in Primary Care

描述(由申请者提供)：被指导对象的目标 以患者为导向的研究职业发展奖(K23)是为了让 申请者(1)获取进行研究所需的知识库 初次服用抗抑郁药后无反应模式分析 初级保健环境中的干预，以及(2)使用该信息来 准确定位那些在初诊时适当看到的无反应患者 辅助性心理社会干预的护理环境。五年奖 将允许申请者完善其在临床流行病学方面的研究技能 和卫生服务研究，并将其应用于临床 有效性试验。这一系列研究的目的是减少 初级保健中抑郁疾病的持续性、复发和残疾 设置。职业发展计划提出了课程作业、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 初级保健环境中的治疗(CBT)和临床疗效试验 在初级保健环境中进行设计。项目1将是对以下项目的辅助数据分析 前瞻性、纵向的公共部门初级保健数据集，以1)确定 可预测反应类别的前处理特征 经过充分的抗抑郁药物试验，以及2)确定时间点 治疗开始后，尚未完全起效的患者 不太可能在经过充分的试验后做到这一点。这样的分析将使我们能够 为了更好地了解对初始问题的各种反应模式 抗抑郁药物干预，它将帮助我们更好地理解 识别关键相关前处理导致无反应的原因 特点。根据上述分析的结果，项目2将进行测试 在基层医院开展多点随机临床试验的可行性 评估有针对性的CBT辅助干预的有效性的CARE， 它将测试应用已确定的前处理措施的可行性 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 多站点R-01申请，将在第三年提交。五 K23年度奖项将使申请者获得所需的研究技能 成为一名独立的研究人员，能够将临床上的 流行病学和护理质量实践研究的优势和 以人群为基础的临床相关性有效性研究的优势 干预研究。申请人的职业生涯将致力于开发 专注于帮助初级保健临床医生有针对性地治疗的研究计划 为难治性抑郁症患者提供高性价比的辅助品 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.