Concordance therapy and medication adherence

一致性治疗与药物依从性 在初级保健环境中改善抗抑郁药依从性的干预措施是有效的，低成本的， 需要易于传播。为了检查这种干预的效用，需要考虑以下几点： 关注首先，个体患者信念的差异可能会显著影响抗抑郁药的依从性 并且可能需要个性化的关注。依从性可能会有所不同，这取决于药物是否 急性使用或持续治疗。此外，依从性干预可能需要不同 这取决于患者是处于急性治疗还是持续治疗。 此外，医疗合并症在抑郁症初级保健患者中很常见， 可能会对药物治疗方案的依从性产生不利影响。事实上，抑郁症状已经 与几种慢性疾病的治疗依从性不足有关，包括糖尿病、冠心病、 动脉疾病、哮喘和高血压。 我们建议评估单一模式依从性干预的有效性（一致性 治疗），由初级保健护士提供，在种族多样化的初级保健患者样本中， 单相抑郁症和共病糖尿病或高血压。我们还将评估 抗抑郁药治疗依从性的改善与口服抗抑郁药治疗依从性的改善相关。 糖尿病或高血压的药物治疗方案。干预措施将专门针对解决 急性抑郁症治疗依从性的确定和具体障碍，以及具体障碍 持续抑郁症治疗期间的依从性。具体而言，我们计划：1评估有效性 一致性治疗改善初级保健单极患者的抗抑郁药依从性 抑郁症和共病糖尿病或高血压; 2）评估 抗抑郁药依从性对参与者依从口服糖尿病药物治疗方案的影响， 高血压

Concordance Therapy and Medication Adherence Interventions to improve antidepressant adherence in primary care settings that are effective, low-cost and easily disseminated are needed. To examine the utility of such interventions, several considerations require attention. First, differences in individual patient beliefs may significantly influence antidepressant adherence and will likely require individualized attention. Adherence may differ depending on whether the medication is being used acutely or in continuation treatment. Moreover, the adherence intervention may need to differ depending on whether the patient is in acute or continuation treatment. In addition, medical comorbidity is common among depressed primary care patients, and depression may have an adverse impact on adherence to medical regimens. In fact, depressive symptoms have been linked to inadequate treatment adherence in several chronic diseases, including diabetes mellitus, coronary artery disease, asthma, and hypertension. We propose to evaluate the effectiveness of a single modality adherence intervention (Concordance Therapy), delivered by primary care nurses, in a racially diverse sample of primary care patients with unipolar depression and comorbid diabetes mellitus or hypertension. We will also evaluate whether improvement in adherence to antidepressant treatment is associated with improvement in adherence to oral medication regimen for diabetes or hypertension. The intervention will be uniquely targeted to address identified and specific barriers to adherence in acute depression treatment, as well as specific impediments to adherence during continuation depression treatment. Specifically we plan to: 1 evaluate the effectiveness of Concordance Therapy to improve antidepressant adherence in primary care patients with unipolar depression and comorbid diabetes mellitus, or hypertension; and 2) To evaluate the impact of changes in antidepressant adherence on participants' adherence to oral medication regimen for diabetes or hypertension.