Reducing Disparities and Improving Care for Depression in OB-GYN Clinics

描述（由申请人提供）：背景：重度抑郁发作发生在女性的整个生命周期中，在生育和绝经过渡期发生率最高。在此期间，妇产科医生是许多妇女经常去看的唯一提供者。低收入和少数族裔妇女特别有可能在妇产科诊所寻求常规护理。在诊断准确性和抑郁护理质量方面，妇产科诊所存在着明显的差距，抑郁症护理质量的差距超过了初级保健诊所。将抑郁症护理纳入临床设置的模型可能适用于妇产科设置，但尚未在围产期之外进行测试。妇产科医生看到的大多数女性都没有怀孕；因此，仅关注围产期抑郁症的研究排除了大量可以从护理中受益的妇女。到目前为止，还没有研究将抑郁症治疗模式作为一个整体适用于妇产科诊所。研究目标：我们提出了一个三部分的干预，与妇产科护理相结合，包括：(1)加强教育；(2)参与;（iii）抑郁症护理管理（包括抗抑郁药物监测和/或提供简短的心理治疗）。我们假设，将三部分抑郁症干预纳入妇产科临床环境，将改善抑郁症的治疗结果、功能结果和抑郁症护理满意度。研究设计：在拟议的随机对照试验中，260名患有重度抑郁症和/或心境恶劣的妇产科临床患者将被分配到：1)综合抑郁症干预或2)常规护理（UC）。我们将筛选约8300名在两家城市妇产科诊所就诊的18个月以上的重度抑郁症/心境恶劣患者。这些患者中有很大一部分是低收入和少数民族妇女。潜在的符合条件的患者也可以由诊所提供者推荐或回复张贴在诊所的信息传单。综合抑郁症干预将持续12个月。通过盲法研究人员的电话访谈，在基线和6、12、18个月时评估结果。目的：我们的主要目的是：1)与UC相比，评估综合妇产科抑郁症干预对抑郁症治疗结果的影响，包括抑郁症状的改变和抑郁症治疗反应；2)与UC相比，评估综合妇产科抑郁症干预对功能结局的影响。我们的次要目的是：3)与UC相比，评估综合妇产科抑郁症干预对抑郁症护理指标质量的影响，包括治疗就诊次数、剂量、持续时间和抗抑郁药物的依从性；对抑郁护理的满意度，包括患者满意度和提供者满意度，以及提供者对妇产科抑郁护理的态度；(4)[确定影响妇产科综合干预可持续性的潜在因素和障碍。]

DESCRIPTION (provided by applicant): Background: Major depressive episodes occur throughout a woman's lifespan, with the highest rates during the reproductive and menopausal transition years. During this time, OB-GYNs are the only providers whom many women regularly see. Low income and minority women are particularly likely to seek their routine care in OB-GYN clinics. There are marked gaps in accuracy of diagnosis and quality of depression care in OB-GYN clinics, with disparities in quality of depression care which exceed those seen in primary care clinics. Models incorporating depression care into clinical settings may be adaptable to OB-GYN settings but have not been tested outside of the perinatal period. Most women seen by OB-GYNs are not pregnant; thus, studies focusing solely on perinatal depression excludes a large number of women who could benefit from care. No studies to date have been completed that have adapted depression care models to OB-GYN clinics as a whole. Research Goal: We propose a three-part intervention, integrated with OB-GYN care, consisting of (i) enhanced education; (ii) engagement; and (iii) depression care management (with antidepressant monitoring and/or provision of brief psychotherapy). We hypothesize that a three-part depression intervention, integrated into the OB-GYN clinical setting, will improve treatment outcomes for depression, functional outcomes, and satisfaction with depression care. Study Design: In the proposed randomized controlled trial, 260 OB-GYN clinic patients with major depression and/or dysthymia will be assigned to either: 1) an integrated depression intervention or 2) usual care (UC). We will screen approximately 8,300 patients presenting for scheduled clinic appointments at two urban OB-GYN clinics over 18-months for major depression/dysthymia. A large number of these patients are low-income and minority women. Potentially eligible patients may also be referred by a clinic provider or reply to informational flyers posted in the clinics. The integrated depression intervention will last 12 months. Outcomes will be assessed at baseline and at 6, 12, and 18 months by telephone interviews by blinded research staff. Aims: Our Primary Aims are: 1) To evaluate, compared to UC, the impact of an integrated OB-GYN depression intervention on depression treatment outcomes, including change in depressive symptoms and depression treatment response; and 2) To evaluate, compared to UC, the impact of an integrated OB-GYN depression intervention on functional outcomes. Our Secondary Aims are: 3) To evaluate, compared to UC, the impact of an integrated OB-GYN depression intervention on quality of depression care indicators, including number of therapy visits, and dose, duration, and adherence to antidepressant medications; and on satisfaction with depression care, including patient and provider satisfaction, and provider attitudes toward depression care in OB-GYN clinics; and 4) [To identify potential facilitators and barriers to sustainability of the integrated OB-GYN intervention.] PUBLIC HEALTH RELEVANCE: The results of our proposed randomized controlled trial will greatly impact public health by satisfying an unmet need for effective depression services for all women seen in the OB-GYN clinical setting. The potential improvements in depression treatment outcomes and quality of life for the large proportion of women who receive their care in this setting will be substantial.