Understanding Prescription Decisions in Schizophrenia

描述(由候选人提供)：这份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专注于严重精神疾病(SMI)患者的药物有效性的研究计划，包括在典型的临床实践环境中调查药物处方的过程和结果，并将这些知识应用于设计干预措施，以改进药物处方决策。我的直接职业目标是了解精神分裂症复杂的、多种药物疗法(“多药疗法”)的处方，特别是在这一应用中的联合抗精神病药物疗法。与临床医生有关的因素(“供应方”)和与病人和家庭有关的(“需求方”)因素都是影响药物管理决策的同等重要和有影响力的因素，都将被考虑在内。为了实现这些目标，我将同时完成教学课程和辅导培训活动，同时还将完成研究项目，重点是处方决策、抗精神病药物综合用药和调查方法，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名拥有心理健康服务研究、精神药理学以及认知和临床心理学专业知识的教职员工的指导下进行。提出了四个项目的研究方案。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患者中多种抗精神病药物处方的患病率和相关性。这些数据将允许评估覆盖广阔地理区域的一系列住院和门诊设施的处方模式。第二和第三项研究将与NIMH R01资助的两项研究一起进行。一个项目将在全国范围内的精神病学家样本中评估影响联合抗精神病药物方案处方决定的可修改的临床医生特征/行为。新的第三个研究项目将调查精神病学家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患者处方决策的评估。了解与抗精神病药物综合用药相关的患者、临床医生和治疗设置因素，同时还揭示可能可修改的处方决策涉及的认知过程的各个方面，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.