Provider Training to Support Patient Self-Efficacy for Depression Care

描述(申请人提供)：许多初级保健患者与可以减少抑郁症状的健康行为作斗争，例如坚持处方治疗。增强患者的自我效能感可以改善健康行为和结果，包括那些与抑郁症相关的行为和结果。然而，目前的自我效能干预是在初级保健之外提供的，因此不能利用治疗性初级保健提供者(PCP)与患者的关系的力量。教授专科医生使用增强自我效能的面谈技巧(见IT)将建立在现有治疗关系的基础上，极大地增加增强自我效能的范围。这项建议中的随机对照试验(RCT)将检验与注意力控制条件相比，在办公室对练习PCP进行短暂(1小时)的干预是否会在未宣布的后续SP遭遇期间(干预后和3个月)显著增加SEE IT的使用。干预措施将由标准化患者(SP)指导员在儿科医生的正常办公时间内提供。所有研究的SP都将描绘同时患有抑郁症和糖尿病的患者，因为这两种情况通常同时发生，并带来促进健康的行为的沉重负担。探索性分析(由于统计能力有限)将探索在真实的抑郁症和糖尿病患者中对以下结果的干预效果：抑郁症和糖尿病的自我效能、自我护理、实际的自我护理行为(例如服药依从性)、症状严重程度和健康状况。RCT前后与利益相关者(PCP、办公室工作人员、患者和SP讲师)的重点小组将指导SEE IT干预的改进。拟议的研究活动将为最终干预措施的未来R01资助、多中心、群组RCT的设计(例如样本量)和实施提供信息，该RCT具有足够的能力来检查对一系列患者结局的影响；对PCP访谈的影响随时间的可持续性；以及对其他实践环境和常见的共病精神健康群组的推广。SEE IT干预开始满足初级保健中抑郁症患者的更广泛的健康需求，并具有独特的潜力，可以减少与精神疾病相关的发病率和死亡率的巨大负担。 公共卫生相关性：这项研究将确定是否可以对执业初级保健提供者(PCP)进行培训，以支持患者在就诊期间对抑郁症和共存的糖尿病进行自我护理，并开始探索这是否可能改善抑郁症和糖尿病的结果。这一点很重要，因为大多数患有这些疾病的患者都在努力进行自我护理，并在初级保健中接受治疗，但初级保健医生很少接受支持自我护理的培训。

DESCRIPTION (provided by applicant): Many primary care patients struggle with health behaviors that can reduce depressive symptoms, such as adhering to prescribed treatments. Bolstering patient self-efficacy can improve health behaviors and outcomes, including those related to depression. However, current self-efficacy interventions are provided outside of primary care, and so cannot harness the power of therapeutic primary care provider (PCP)-patient relationships. Teaching PCPs to employ self-efficacy enhancing interviewing techniques (SEE IT) with patients would build upon existing therapeutic relationships, greatly increasing the reach of self-efficacy enhancement. The randomized controlled trial (RCT) in this proposal will examine whether, as compared with an attention control condition, a brief (< 1 hour) office-based intervention for practicing PCPs will lead to significantly greater use of SEE IT during unannounced follow-up SP encounters (post- intervention and 3 months). The interventions will be delivered to PCPs during their regular office hours by standardized patient (SP) instructors. All study SPs will portray patients with both depression and diabetes, since these conditions commonly co-occur and entail a heavy burden of health-enhancing behaviors. Exploratory (due to limited statistical power) analyses will explore intervention effects on the following outcomes among real patients with co-occurring depression and diabetes: self-efficacy for depression and diabetes self-care, actual self-care behaviors (e.g. medication adherence), symptom severity, and health status. Pre- and post-RCT focus groups with stakeholders (PCPs, office staff, patients, and SP instructors) will guide refinement of the SEE IT intervention. The proposed research activities will inform the design (e.g. sample size) and conduct of a future R01-funded, multi-center, cluster RCT of the finalized intervention, adequately powered to examine effects on a range of patient outcomes; sustainability of effects on PCP interviewing over time; and generalizability to other practice settings and common co-morbid mental health clusters. The SEE IT intervention begins to address the broader health needs of individuals with depression in primary care, and has unique potential to reduce the tremendous burden of mental illness- related morbidity and mortality. PUBLIC HEALTH RELEVANCE: This study will determine whether practicing primary care providers (PCPs) can be trained to support patient self-care of depression and co-existing diabetes during office visits, and begin to explore whether this might improve depression and diabetes outcomes. This is important because most patients with these conditions struggle with self-care and are seen in primary care, yet PCPs are seldom trained to support self-care.