Adherence to Depression Treatment Among Older Patients

NIMH指导的以患者为导向的研究职业发展奖（K23奖）的申请寻求支持，以开发与心血管疾病（CVD）老年人抑郁症治疗相关的研究计划。这个应用程序利用了我在家庭医学和临床流行病学的背景，并提出了旨在发展我的能力，设计，实施和评估针对 治疗老年心血管疾病患者的抑郁症。旨在解决CVD合并症的抑郁症干预措施将为初级保健环境中老年人的抑郁症治疗与其他慢性疾病的护理整合提供一个模型。我在临床家庭医学、流行病学和生物统计学方面的知识，以及我实施大型初级保健研究的经验，为我提供了一个很好的机会。 作为干预研究者的发展背景。宾夕法尼亚大学提供了一个优秀的研究环境，以帮助实现这一K23的目标：（1）研究患者的特点，使老年人抑郁症和心血管疾病的风险不遵守抑郁症治疗;（2）获得先进的统计方法，如结构方程模型和新的研究设计，这两者都是不可或缺的我的研究， 坚持在初级保健设置;和（3）设计干预措施，抑郁症的老年初级保健患者心血管疾病。除了教育活动外，该申请还提出了一项分三个阶段展开的研究计划。在NIMH资助的一项研究中，第一阶段将检查与老年心血管疾病初级保健患者坚持推荐的抑郁治疗相关的因素，该研究旨在测试旨在改善心血管疾病患者抑郁症状的干预措施的有效性。 抑郁症的识别和治疗（前景研究）。重点将是如何心血管并发症，执行和认知功能，对抑郁症及其治疗，社会支持，和其他患者水平的因素与老年初级保健患者的抑郁症治疗依从性相关。在第二阶段，对老年初级保健患者进行半结构化访谈，探讨患者对抑郁与心血管疾病及其 治疗和患者偏好的可能策略，旨在提高抑郁症治疗的依从性。第三阶段将测试一项旨在治疗老年CVD患者的干预方案的可行性。方案将基于阶段1和阶段2的结果。在第4阶段，第1、2和3阶段的结果将指导R 01干预研究的最终开发，概述见本K23的最后一节。该项目将设置 阶段的发展和实施干预措施，以提高抑郁症的治疗依从性与共存的心血管疾病的人。

This application for an NIMH Mentored Patient-Oriented Research Career Development Award (K23 Award) seeks support to develop a program of research related to the treatment of depression in older adults with cardiovascular disease (CVD). This application capitalizes on my background in family medicine and clinical epidemiology and proposes activities aimed at developing my ability to design, implement, and evaluate interventions directed at the treatment of depression in older primary care patients with CVD. An intervention for depression designed to address CVD comorbidity would provide a model for integration of depression treatment with care for other chronic medical conditions among older adults in the primary care setting. My knowledge of clinical family medicine, epidemiology, and biostatistics, as well as my experience of implementing a large primary care-based study provide an excellent background for development as an intervention researcher. The University of Pennsylvania offers an outstanding research environment to help accomplish the goals of this K23: (1) to study the patient characteristics that place older adults with depression and CVD at risk for nonadherence to depression treatment; (2) to obtain expertise in advanced statistical methods, e.g. structural equation models and new study designs, both of which are integral to my study of adherence in primary care settings; and, (3) to design interventions for depression among older primary care patients with CVD. In addition to educational activities, this application lays out a research plan unfolding in three phases. Phase I will examine factors associated with adherence to recommended depression therapy in older primary care patients with CVD in an NIMH-funded study designed to test the effectiveness of an intervention aimed at improving the recognition and treatment of depression (the PROSPECT study). The focus will be on how cardiovascular comorbidity, executive and cognitive functioning, beliefs about depression and its treatment, social support, and other patient-level factors are associated with adherence to depression treatment in older primary care patients. In Phase 2, semi-structured interviews of older primary care patients will explore patient concepts of depression in relation to CVD and its treatment and patient preferences for possible strategies aimed at improving adherence to depression treatment. Phase 3 will test the feasibility of a protocol for an intervention aimed at the treatment of older adults with CVD. The protocol will be based on the results from Phases 1 and 2. During Phase 4, the findings from Phases 1, 2, and 3 will guide the final development of an R01 intervention study, sketched out in the final section of this K23. This project will set the stage for the development and implementation of interventions to improve depression treatment adherence among persons with co-existing CVD.