Web-Based Program to Improve Antidepressant Medication Adherence

描述（由申请人提供）：情绪障碍，包括重度抑郁症、心境恶劣和双相情感障碍，影响了近2100万美国人，占美国18岁及以上人口的9.5%。在心理健康问题中，重度抑郁症是美国15-44岁人群致残的主要原因，每年影响近1500万成年人。虽然研究清楚地表明，按照国家指导方针服用抗抑郁药物对治疗重度抑郁症有疗效，但如果患者不按规定服用药物，疗效就会打折扣。据估计，不坚持服用抗抑郁药物的比例从20%到59%不等。不坚持治疗的原因包括不良副作用、完成疗程前的临床改善、对依赖的恐惧、服用精神药物时的不适、缺乏治疗效果以及希望不用药物就能解决问题。为了提高患者对治疗方案的依从性，已经实施了许多干预措施，但最有效的方案往往是复杂的，劳动密集型的，这使得麦克唐纳和她的同事得出结论，需要对创新方法进行更多的研究。ISA Associates与Aetna行为健康护理和Redmon集团合作，提议开发和试点测试一个基于网络的抗抑郁药物依从性项目的原型，抑郁症的生活步骤，用于诊断为重度抑郁症和处方抗抑郁药物的个人。该原型将基于Safren成功的Life Steps药物依从性方法。一旦原型开发出来，它将在60名Aetna行为健康会员的样本中进行试点测试，这些会员都是新开的抗抑郁药物，并有相应的重度抑郁症诊断。由于原型的有限性，其中只有最终节目内容的一个样本将被充分开发，可行性将基于与原型内容相关的自我报告结果测量。这些措施将包括抑郁症知识、药物和依从性；医患互动中的感知效能；应对副作用；药物依从性自我效能；[和药物依从性]。参与者将在基线和两个月完成调查。描述了进入第二阶段的第一阶段里程碑和基准。如果显示出效果，基于网络的“抑郁症生活步骤”将提供给所有通过互联网获得抗抑郁药物的个人，极大地扩展了药物依从性项目的范围。拟建的研究团队包括：Hersch和Billings已经成功地创建并测试了几个基于网络的行为健康项目，包括Smart Rx（处方药滥用预防项目）和压力和情绪管理（解决压力、抑郁、焦虑和有效治疗）。Drs。Hersch和Billings将得到哈佛医学院心理学副教授Steve Safren博士和华盛顿大学医学中心精神病学和行为科学系副主任、精神病学教授Wayne Katon博士的协助。Steve Safren博士是生命步骤方法的开发者。

DESCRIPTION (provided by applicant): Mood disorders, including major depressive disorder, dysthymia, and bipolar disorder, affect nearly 21 million Americans or 9.5% of the U.S. population age 18 years of age and older. Among mental health problems, major depressive disorder is the leading cause of disability in the U.S. for people ages 15-44, affecting nearly 15 million adults each year. While research has clearly shown the efficacy of antidepressant medication for treating major depression when medications are taken in accordance with national guidelines, that efficacy is compromised when patients do not take medications as prescribed. Estimates for non-adherence to antidepressant medications range from 20% to 59%. Reasons for non-adherence range from adverse side effects, clinical improvement prior to completing treatment course, fear of dependence, discomfort with taking psychotropic medications, lack of treatment effectiveness, and desire to solve problems without drugs. Many interventions have been implemented in an attempt to improve patient adherence to treatment regimens, but the most effective programs are often are often complex and labor intensive leading McDonald and her colleagues to conclude that more studies of innovative methods are needed. ISA Associates, in partnership with Aetna Behavioral Health Care and the Redmon Group, proposes to develop and pilot test a prototype web-based antidepressant medication adherence program, Life Steps for Depression, for individuals diagnosed with major depressive disorder and prescribed antidepressant medication. The prototype will be based on Safren's successful Life Steps medication adherence approach. Once the prototype is developed, it will be pilot tested with a sample of 60 Aetna Behavioral Health members who are newly prescribed antidepressant medication and have a corresponding diagnosis of major depressive disorder. Because of the limited nature of the prototype, in which only a sample of the final program content will be fully developed, feasibility will be based on self-reported outcome measures related to the prototype content. These measures will include knowledge of depression, medications, and adherence; perceived efficacy in patient-physician interactions; coping with side effects; medication adherence self-efficacy; [and medication adherence]. Participants will complete the survey at baseline and two months. Phase I milestones and benchmarks for proceeding to Phase II are described. If shown effective, the web-based Life Steps for Depression would be available to all individuals prescribed antidepressant medications for depression with access to the Internet, greatly expanding the reach of medication adherence programs. The proposed research team including Drs. Hersch and Billings have successfully created and tested several web-based behavioral health programs, including Smart Rx (a prescription drug misuse prevention program) and Stress and Mood Management (which addresses stress, depression, anxiety, and treatments that work). Drs. Hersch and Billings will be assisted by Dr. Steve Safren, Associate Professor in Psychology, Harvard Medical School and developer of the Life Steps approach, and Dr. Wayne Katon, Professor of Psychiatry and Vice Chair of the Department of Psychiatry and Behavioral Sciences at the University of Washington Medical Center. PUBLIC HEALTH RELEVANCE: Clinical evidence now shows that there are safe and effective antidepressant medications that can be used to treat major depressive disorder. However, many individuals fail to complete the minimum recommended six month treatment regimen for a wide variety of reason. Recent data suggests that there are collaborative care and telephone outreach approaches that can increase medication compliance and improve clinical outcomes. Unfortunately, the reach of these interventions is limited by their cost and relative inaccessibility. The outcome of this Phase I project will be a prototype of an innovative, web-based medication adherence program for individuals diagnosed with major depressive disorder who are being treated with antidepressant medications. Such a program, if effective, will greatly expand access to an effective medication adherence program, thereby improving the clinical outcomes of people with depression and reducing the likelihood of depression relapse.