Provider Training to Support Patient Self-Efficacy for Depression Care

描述（由申请人提供）：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，包括与抑郁症相关的行为和结果。然而，目前的自我效能干预提供初级保健之外，因此不能利用治疗初级保健提供者（PCP）-患者关系的力量。教授PCP采用自我效能增强访谈技术（SEE IT）与患者将建立在现有的治疗关系，大大增加自我效能增强的范围。本提案中的随机对照试验（RCT）将研究与注意力控制条件相比，对实践PCP进行短暂（< 1小时）基于办公室的干预是否会导致在未经宣布的随访SP遭遇期间（干预后和3个月）显著更多地使用SEE IT。这些干预措施将由标准化患者（SP）指导员在正常办公时间内提供给PCP。所有研究SP都将描述患有抑郁症和糖尿病的患者，因为这些疾病通常同时发生，并带来健康促进行为的沉重负担。探索性（由于统计功效有限）分析将探索干预对抑郁症和糖尿病并存的真实的患者的以下结局的影响：抑郁症和糖尿病自我护理的自我效能、实际自我护理行为（例如，药物依从性）、症状严重程度和健康状况。与利益相关者（PCP、办公室工作人员、患者和SP讲师）的RCT前后焦点小组将指导SEE IT干预的完善。拟议的研究活动将为最终干预措施的未来R 01资助的多中心集群RCT的设计（例如样本量）和实施提供信息，该RCT有足够的动力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共病心理健康集群的可推广性。SEE IT干预措施开始解决初级保健中抑郁症患者更广泛的健康需求，并具有减少精神疾病相关发病率和死亡率的巨大负担的独特潜力。

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.