METRIC: Measurement, Education and Tracking in Integrated Care: Strategies to Increase Patient Engagement and Reduce Mental Health Disparities among Hispanics

 描述（由申请人提供）：西班牙裔人群中抑郁症治疗的障碍包括持续的耻辱感、医患沟通不足（DPC）以及由此导致的抗抑郁药物的次优使用。成见之所以长期存在，主要是由于对疾病的认识不足和文化因素。拉美裔人对抑郁症治疗的共同担忧包括担心抗抑郁药的成瘾性和有害性，担心服用过多的药片，以及服用精神药物的耻辱。初级保健环境往往是识别未诊断或未治疗的精神健康障碍的门户，特别是对于患有共病身体健康状况的人。特别是西班牙裔，更有可能在初级保健机构接受精神卫生保健。美国预防服务工作组最近的建议是，初级保健提供者只有在系统到位，以确保充分的治疗和随访的情况下，才能对成年患者进行抑郁症筛查。这项拟议的研究旨在建立在成人初级保健安全网环境中普遍筛查抑郁症的可行性，衡量文化上适当的抑郁症教育干预措施的有效性，以减少污名化并增加西班牙裔人对抑郁症治疗的接受，并实施基于测量的综合护理（MBIC）模式，包括协作，多学科治疗和文化定制的护理管理策略。具体目标1：检查抑郁症教育Fotonovela（DEF）的具体效果，以增加对抑郁症的了解，减少耻辱感，并增加西班牙裔患者对抑郁症治疗的参与。具体目标二：评估基于测量的综合护理（MBIC）治疗抑郁症的影响，在一个社区为基础的联邦合格的健康中心（CIMHC）在北德克萨斯州的患者人群是大多数西班牙裔。具体目标3：研究利用创新的iPad抑郁症筛查技术在成人初级保健患者中进行普遍筛查和准确检测抑郁症的可行性。

 DESCRIPTION (provided by applicant): Barriers to depression treatment among Hispanic populations include persistent stigma, inadequate doctor patient communication (DPC) and resultant sub-optimal use of anti-depressant medications. Stigma is primarily perpetuated due to inadequate disease literacy and cultural factors. Common concerns about depression treatment among Hispanics include fears about the addictive and harmful properties of antidepressants, worries about taking too many pills, and the stigma attached to taking psychotropic medications. Primary care settings often are the gateway to identifying undiagnosed or untreated mental health disorders, particularly for people with comorbid physical health conditions. Hispanics, in particular, are more likely to receive mental health care in primary care settings. Recent recommendations from the U.S. Preventive Services Task Force are that primary care providers screen adult patients for depression only if systems are in place to ensure adequate treatment and follow-up. The proposed study seeks to establish the feasibility of universal screening for depression in an adult primary care safety net setting, measure the effectiveness of a culturally appropriate depression education intervention to reduce stigma and increase uptake in depression treatment among Hispanics, and implement a Measurement-Based Integrated Care (MBIC) model with collaborative, multi-disciplinary treatment and culturally tailored care management strategies. Specific Aim 1: Examine the specific effects of a Depression Education Fotonovela (DEF) to increase knowledge of depression, reduce stigma and increase engagement in depression treatment among Hispanic patients. Specific Aim 2: Evaluate the impact of Measurement-Based Integrated Care (MBIC) for the treatment of depression in one community-based Federally Qualified Health Centers (FQHC) in North Texas whose patient population is majority Hispanic. Specific Aim 3: Examine the feasibility of universal screening and accurate detection of depression among adult primary care patients utilizing innovative iPad Depression Screening technology.