Treatment Effectiveness in Depressed Patients with COPD

慢性阻塞性肺病抑郁症患者的治疗效果

• 批准号: 6662498
• 负责人: GEORGE S ALEXOPOULOS
• 金额: $ 53.22万
• 依托单位: WEILL MEDICAL COLL OF CORNELL UNIV
• 依托单位国家: 美国
• 财政年份: 2002
• 资助国家: 美国
• 起止时间: 2002-09-30 至 2007-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6662498
• 关键词: allied health personnel; antidepressants; behavioral /social science research tag; chronic obstructive pulmonary disease; clinical research; comorbidity; functional ability; health behavior; health care service evaluation; health care service utilization; health education; health services research tag; home health care; human old age (65+); human subject; human therapy evaluation; interview; longitudinal human study; major depression; mental disorder chemotherapy; patient care management; patient oriented research; psychological tests; social support network; suicide; therapy compliance

DESCRIPTION (provided by applicant): COPD affects 15 percent of older adults and is the fourth leading cause of death in the US. Approximately 20 percent of COPD patients have major depression, a condition that contributes to suffering but also to poor treatment adherence leading to increased disability and morbidity. The study will investigate the effectiveness of an intervention aimed at facilitating the implementation and adherence to a treatment algorithm based on AHCPR guidelines in depressed COPD patients. The cornerstone of the intervention is the use of Health Specialists (HS), who will collaborate with the patients? own physicians and help them to offer timely and appropriately targeted treatment recommendations for pharmacotherapy. The HS will also visit patients at their homes and offer education, directions and support aimed at improving their adherence to medical, psychiatric, and rehabilitative recommendations. In addition, the HS will provide to families, and physicians education on depression. We hypothesize that this intervention will increase the prescription of adequate antidepressant treatment by physicians, enhance treatment adherence by patients, and reduce depressive symptomatology, suicidal ideation, and disability over a 26-week post-discharge follow-up period. The subjects will be 180 elderly patients consecutively admitted to two pulmonary rehabilitation centers (2-week length of stay), suffering from major depression and COPD. The impact of the intervention (offered to half of the sample, N=90) will be contrasted with that of usual care (N=90). We targeted in this study one of the most disabled and suffering segments of the population. We used, in our design, our research experience with depressed COPD patients, the PROSPECT multicenter study of primary care elderly patients, our home care study, and the geriatric depression studies of our Intervention Research Center. If found effective, this "intervention" can be broadly implemented, as it can be used by visiting nurse staff after retraining. Finally, we believe that our approach to the care of depressed, medically ill patients can generate a practice model that has the ability to rapidly incorporate advances made in clinical science.

描述（由申请人提供）：COPD 影响 15% 的老年人 并且是美国第四大死因。大约 20% 慢性阻塞性肺病患者患有重度抑郁症，这是一种导致痛苦的疾病 还导致治疗依从性差，导致残疾增加 发病率。该研究将调查干预措施的有效性 旨在促进治疗算法的实施和遵守 基于 AHCPR 针对抑郁 COPD 患者的指南。的基石 干预是使用健康专家 (HS)，他们将与 病人？拥有自己的医生并帮助他们及时、适当地提供服务 药物治疗的针对性治疗建议。 HS还将视察 在家中为患者提供教育、指导和支持，旨在 提高他们对医疗、精神科和康复治疗的依从性 建议。此外，HS 还将向家庭和医生提供 抑郁症教育。我们假设这种干预将会增加 医生开出适当的抗抑郁治疗处方，增强 患者坚持治疗，减少抑郁症状、自杀倾向 出院后 26 周随访期间的意念和残疾情况。这 受试者为 180 名连续入院两次肺科的老年患者。 康复中心（住院两周），患有重度抑郁症 和慢性阻塞性肺病。干预措施的影响（提供给一半样本，N=90） 将与常规护理（N=90）进行对比。我们本次研究的目标是 人口中最残疾和最痛苦的群体之一。我们用过，在 我们的设计、我们对抑郁 COPD 患者的研究经验、前景 针对初级保健老年患者的多中心研究、我们的家庭护理研究以及 我们干预研究中心的老年抑郁症研究。如果发现 有效，这种“干预”可以广泛实施，因为它可以被 再培训后拜访护士人员。最后，我们相信我们的方法 抑郁症患者的护理可以产生实践模型 它有能力快速整合临床科学的进步。