Trial of Asthma Self-Management Education in Patients with Depressive Symptoms

描述(由申请人提供)：K24候选人是一名普通内科医生，具有哮喘临床研究同行评议的发展轨迹，并拥有通过临床流行病学和卫生服务研究的正式硕士学位课程指导临床研究研究员和初级教员的丰富经验。在RWJ学院学者奖、NHLBI K23奖和NHLBI翻译行为科学合同的支持下，候选人成功地完成了一系列试验，评估干预措施以改善初级保健哮喘患者的自我管理和降低心血管风险。这项工作的扩展正在NHLBI R01试验中进行，以改善哮喘急诊室患者的自我管理。在这项工作中，反复出现的主题是抑郁症状是哮喘预后不良的风险。这个K24奖项的目标是在以前工作的基础上，实施一种新的教育干预措施，专门针对有抑郁症状的哮喘患者。K24随机对照试验将教授患者基于表现的技能，并使用创新的方法来提高自我效能。一年后的结果将是生活质量、急救资源利用、缺勤和需要抢救药物。这项试验将首次聚焦于有抑郁症状的哮喘患者，这是一个高危人群，他们关于自我管理的教育需求在很大程度上被忽视了。另一个目标是应聘者根据严格的标准，使用DSM-IV轴I障碍标准结构化临床面试(SCID)来发展诊断抑郁障碍的专业知识。候选人的短期目标是关注有抑郁症状的哮喘患者，优化他们的自我管理指导，并根据正式的精神病学标准诊断他们的抑郁障碍谱。这位候选人的长期目标是开发同时治疗哮喘和抑郁症的干预措施。其他相关领域的短期目标是在最近完成的哮喘患者体力活动随机对照试验的基础上，通过实施行为干预来增加哮喘患者的运动，并通过实施干预措施来减少哮喘紧急资源的使用，以正在进行的急诊室随机对照试验的结果为基础。这两个目标将在R01应用程序中得到解决。作为威尔康奈尔医学研究生院硕士学位项目和AHRQ T32临床流行病学和卫生服务研究联席主任，这位K24候选人在制定严格的临床研究培训计划以及指导研究员和初级教员方面发挥了重要作用。这位候选人在培训医生成为独立的临床研究人员方面有着成功的记录，这些医生拥有同行评审的资金和学术任命。在K24颁奖期间，候选人将通过减少她对硕士项目日益增长的管理责任来增加她作为主要导师的角色。该奖项还将为候选人提供时间，让她将自己的角色扩展到指导住院医师。康奈尔大学为K24候选人提供了丰富的研究环境，包括专家和合作者。特别是，候选人是研究方法核心的活跃成员，研究方法核心是一个由知名的多学科临床研究人员组成的“智囊团”，专注于研究方法以及临床试验的设计和实施方面的挑战。该中心在支持职业生涯中期和高级研究人员的研究活动方面取得了极大的成功。此外，K24候选人已经与肺部医学和精神病学方面的专家建立了研究关系，并将继续利用他们的知识来满足这次多学科K24试验的目标。总而言之，K24奖将允许候选人进行一项针对结果不佳的高风险哮喘患者的随机对照试验，从而促进她的研究生涯。该奖项还将允许她获得使用SCID诊断抑郁障碍的专业知识，并开发哮喘和抑郁症的联合干预措施。这些都是推进她的研究事业的必要步骤。K24奖项还将给予候选人专门的时间提供一对一的指导，招募对肺部医学研究感兴趣的指导对象，在硕士计划中建立临床哮喘研究的核心，并为住院医师建立指导角色。受训者将能够参加新的哮喘随机对照试验，以及作为本申请的一部分建议的随机对照试验。更多的指导时间将通过减少当前花费的时间和扩大硕士项目的管理责任来获得。 公共卫生相关性：哮喘影响着2200万美国所有年龄段的人，并与日常活动中断、急诊室就诊和住院等严重不良后果有关。许多哮喘患者也有明显的抑郁症状，这使得哮喘管理更加困难，并导致更糟糕的结果。这项研究的目的是帮助有抑郁症状的哮喘患者更好地管理哮喘，改善预后，特别是更好的生活质量和更少的紧急治疗需要。

DESCRIPTION (provided by applicant): The K24 candidate is a general internist with a trajectory of peer-reviewed clinical research in asthma and extensive experience in mentoring fellows and junior faculty in clinical research through a formal Masters Degree Program in Clinical Epidemiology and Health Services Research. Supported by an RWJ Faculty Scholars Award, an NHLBI K23 award, and an NHLBI Translational Behavioral Science contract, the candidate has successfully completed a series of trials assessing interventions to improve self-management and to reduce cardiovascular risk in primary care asthma patients. An extension of this work is in progress in an NHLBI R01 trial to improve self-management in patients presenting to the emergency room for asthma. Throughout this work, the recurring theme of depressive symptoms as a risk for poor asthma outcomes has emerged. The objectives of this K24 award are to build on prior work and implement a new educational intervention targeted specifically at asthma patients with depressive symptoms. The K24 RCT will teach patients performance-based skills and use an innovative method to increase self-efficacy. The outcomes after 1 year will be quality of life, emergency resource utilization, work absenteeism, and the need for rescue medications. This trial will be the first to focus on asthma patients with depressive symptoms, a high risk population whose needs regarding education about self-management have been largely overlooked. An additional objective is for the candidate to develop expertise in diagnosing depressive disorders according to strict criteria using the standard Structured Clinical Interview for DSM-IV Axis I Disorders (SCID). The candidate's short-term goals are to focus on asthma patients with depressive symptoms, to optimize their instruction in self-management, and to diagnose their spectrum of depressive disorders according to formal psychiatric criteria. The candidate's long-term goals are to develop interventions to simultaneously treat asthma and depression. Short-term goals in other related areas are to build on a recently completed RCT in physical activity in asthma patients by implementing a behavioral intervention to increase exercise among asthma patients, and to build on the findings of an ongoing emergency room RCT by implementing an intervention to decrease urgent resource utilization for asthma. Both goals will be addressed in R01 applications. As co-Director of the Masters Degree Program and AHRQ T32 Fellowship in Clinical Epidemiology and Health Services Research at the Weill Cornell Graduate School of Medical Sciences, the K24 candidate has been instrumental in developing a rigorous training program in clinical research and in mentoring fellows and junior faculty. The candidate has a successful track record of training physicians who become independent clinical investigators with peer-reviewed funding and academic appointments. During the K24 award, the candidate will increase her role as a primary mentor by decreasing her growing administrative responsibilities to the Masters Program. The award also will provide time for the candidate to extend her role to mentor medical residents. A rich research environment with experts and collaborators is available at Cornell for the K24 candidate. In particular, the candidate is an active member of the Research Methodology Core, a 'think tank' of established multi-disciplinary clinical researchers focusing on challenges in research methodology and the design and conduct of clinical trials. The Core has been extremely successful in supporting research initiatives of mid-career and senior investigators. In addition, the K24 candidate has established research relationships with experts in pulmonary medicine and psychiatry, and will continue to draw on their knowledge to meet the objectives of this multi-disciplinary K24 trial. In summary, the K24 award would advance the candidate's research career by permitting her to conduct an RCT targeted at asthma patients at high risk for poor outcomes. The award also would permit her to acquire expertise in diagnosing depressive disorders using the SCID and to develop co- interventions for asthma and depression. These are necessary steps to advance her research career. The K24 award also would grant the candidate dedicated time to provide one-on-one mentoring, to recruit mentees interested in research in pulmonary medicine, to establish a core of clinical asthma research in the Masters Program, and to establish a mentoring role for medical residents. Mentees will be able to participate in new asthma RCTs as well as the RCT proposed as part of this application. More time for mentoring will be derived by decreasing time spent in current and expanding administrative responsibilities to the Masters Program. PUBLIC HEALTH RELEVANCE: Asthma affects 22 million Americans of all ages and is associated with significant adverse outcomes ranging from disruption of daily activities to emergency room visits and hospitalizations. Many asthma patients also have marked depressive symptoms, which make asthma management more difficult and lead to worse outcomes. The purpose of this study is to help asthma patients who have depressive symptoms better manage asthma and have improved outcomes, particularly better quality of life and less need for emergency treatment.