Understanding Prescription Decisions in Schizophrenia

描述（由候选人提供）：此修订后的申请概述了NIMH K01指导研究科学家发展奖的综合培训和研究计划。我的长期职业目标是开发一个研究项目，重点研究严重精神疾病（SMI）患者的药物有效性，包括调查典型临床实践环境下药物处方的过程和结果，并将这些知识应用于干预措施的设计，以改善药物处方决策。我的近期职业目标是了解精神分裂症中复杂的、多药物治疗方案（“多药治疗”）的处方，特别是在这种应用中的联合抗精神病药物治疗方案。与临床医生相关的（“供应方”）和与患者和家庭相关的（“需求方”）因素，这些因素同样重要，影响药物管理决策的力量将被考虑。为了实现这些目标，我将完成教学课程和指导培训活动，同时进行研究项目，重点是处方决策，抗精神病药物综合治疗，调查方法，以及改善精神分裂症处方决策的干预措施的开发。这些活动将在来自全国各地的几位教师的指导下进行，他们在精神卫生服务研究，精神药理学以及认知和临床心理学方面具有专业知识。提出了四个课题的研究计划。第一项研究将使用退伍军人管理局的行政遭遇数据来检查精神分裂症中多种抗精神病药物处方的患病率和相关性。这些数据将允许对覆盖广大地理区域的一系列住院和门诊设施的处方模式进行评估。第二和第三项研究将与NIMH R01资助的两项研究一起进行。其中一个项目将在全国范围内的精神科医生样本中评估影响联合抗精神病药物处方决策的可改变的临床医生特征/行为。新的第三个研究项目将调查精神科医生对精神分裂症采用循证治疗的意愿，以及他们对各种教育干预形式的偏好。第四项研究通过关注患者和家庭在这一过程中的作用，扩展了对精神分裂症处方决策的评估。了解患者、临床医生和治疗设置因素与抗精神病药物多药相关，同时揭示处方决策中可能可改变的认知过程，将为后续开发旨在改善精神分裂症患者处方决策过程的R01应用程序提供信息。

DESCRIPTION (provided by candidate): This revised application outlines an integrated training and research program for a NIMH K01 Mentored Research Scientist Development Award. My long-term career goal is to develop a program of research focused on medication effectiveness in individuals with serious mental illnesses (SMI) that includes investigating the process and outcomes of medication prescription in typical clinical practice settings, and applying this knowledge to the design of interventions to improve medication prescription decisions. My immediate career goal is to understand the prescription of complex, multi-drug regimens ('polypharmacy') in schizophrenia, focusing specifically on combination antipsychotic regimens in this application. Both clinician-related ('supply-side') and patient and family-related ('demand-side') factors, which are equally important and influential forces affecting medication management decisions will be considered. To achieve these goals, I will complete didactic coursework and mentored training activities concurrently with research projects that focus on prescription decision-making, anti-psychotic polypharmacy, and survey methods, as well as the development of interventions to improve prescription decisions in schizophrenia. These activities will be conducted under the guidance of several faculty members from across the country with expertise in mental health services research, psychopharmacology, and both cognitive and clinical psychology. A research plan of four projects is proposed. The first study will use Veterans Administration administrative encounter data to examine the prevalence and correlates of prescription of multiple antipsychotic medications in schizophrenia. This data will permit the evaluation of prescribing patterns across a range of inpatient and outpatient facilities covering a vast geographic area. The second and third studies will be conducted in conjunction with two funded NIMH R01 grants. One project will evaluate the modifiable clinician characteristics/behaviors that influence prescription decisions regarding combined antipsychotic regimens in a nation-wide sample of psychiatrists. The new third research project will examine the willingness of psychiatrists to adopt evidence-based treatments for schizophrenia and their preferences for various formats for educational interventions. The fourth study expands the evaluation of prescription decision-making in schizophrenia by focusing on the roles of both the patient and the family in this process. Understanding the patient, clinician, and treatment setting factors that are correlated with antipsychotic polypharmacy, while also uncovering aspects of the cognitive processes involved in prescription decision-making that may be modifiable, will inform the subsequent development of an R01 application aimed at improving the process of prescription decision-making for persons with schizophrenia.