Patient Centered Depression Care for African-Americans

以患者为中心的非裔美国人抑郁症护理

• 批准号: 6598412
• 负责人: LISA A COOPER
• 金额: $ 51.9万
• 依托单位: JOHNS HOPKINS UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2003
• 资助国家: 美国
• 起止时间: 2003-09-30 至 2008-09-29
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6598412
• 关键词: African American; DVD /CD ROM; caucasian American; clinical research; counseling; culture; depression; health behavior; health care service utilization; health services research tag; human subject; interactive multimedia; mental disorder chemotherapy; mental disorder prevention; mental health services; patient care personnel relations; patient oriented research; preference; primary care physician; psychotherapy; racial /ethnic difference

DESCRIPTION: (Provided by the Applicant) Several studies document underutilization of outpatient specialty mental health services by African Americans. However, African Americans with depression are just as likely as whites to receive care in primary care settings. Despite their use of primary care services, African American patients are less likely than whites to be recognized as depressed, offered pharmacotherapy, and to initiate or complete pharmacotherapy or psychotherapy for depression. Compared to whites, African American patients express stronger preferences for counseling and more negative attitudes toward antidepressant medication, the most common form of treatment of depression used by primary care physicians. African Americans are also more likely to see depression and its treatment through a spiritual framework. Studies show that African Americans receive less optimal technical and interpersonal health care than whites for many conditions, including depression. Depression is a common chronic condition that results in substantial morbidity, functional disability, and resource use. Despite the proven efficacy of pharmacotherapy and psychotherapy for treatment of depression, many depressed primary care patients of all races and ethnicities still do not receive adequate treatment. Recent quality improvement trials for depression in primary care have shown improvements in outcomes; however, there is room for improvement, particularly for ethnic minority patients. Interventions focusing on patient-centeredness have documented benefits on patient adherence, patient satisfaction, and health outcomes. Yet, only a few recent quality improvement strategies for depression include patient-centered accommodations. We have created a patient-centered adaptation that includes many of the components of recent successful quality improvement interventions for depression in primary care. The proposed study compares a standard depression intervention for patients (delivered by a depression case manager) and physicians (review of guidelines and structured mental health consultation) to a patient-centered intervention for patients (incorporates patient activation, individual preferences, and cultural sensitivity) and physicians (incorporates participatory communication skills training with individualized feedback on interactive CD-ROM). Thirty physicians and 250 patients will be randomized to either the standard interventions or the culturally tailored interventions. The main hypothesis is that patients in the patient-centered, culturally tailored intervention group will have higher remission rates from depression and lower levels of depressive symptoms at 12 months than patients in the standard intervention care group. Secondary outcomes will include patient receipt of guideline concordant care, patient and physician satisfaction with care, patient-physician communication behaviors, patient and physician attitudes toward depression, and self-efficacy in managing depression. This study will add to knowledge about how to effectively engage African American patients in care of depression and serve as a prototype of how to incorporate patient-centeredness in programs to reduce racial and ethnic disparities in health care for common conditions.

描述：（由申请人提供）一些研究证明非裔美国人对门诊特种心理健康服务的利用不足。但是，患有抑郁症的非裔美国人在初级保健环境中接受护理的可能性与白人一样的可能性。尽管使用初级保健服务，但非裔美国人患者的可能性远低于白人被认为是抑郁症，提供药物治疗，启动或完整的药物治疗或抑郁症心理治疗的可能性。与白人相比，非裔美国人患者对咨询和对抗抑郁药的负面态度表达了更强的偏好，这是初级保健医师使用的最常见抑郁症治疗形式。非裔美国人也更有可能通过精神框架看到抑郁症及其治疗。研究表明，在包括抑郁症在内的许多情况下，非洲裔美国人获得的技术和人际和人际和人际和人际和人际和人际护理少。抑郁症是一种常见的慢性病，​​可导致大量发病率，功能残疾和资源使用。尽管药物治疗和心理治疗对抑郁症的治疗具有证实，但许多种族和种族的抑郁症患者仍然没有得到足够的治疗。最近针对初级保健抑郁症的质量改善试验显示了结果的改善。但是，有改善的余地，特别是对于少数民族患者而言。以患者为中心的干预措施记录了对患者依从性，患者满意度和健康结果的好处。然而，抑郁症的近期质量改善策略包括以患者为中心的住宿。我们创建了一个以患者为中心的适应性，其中包括最近成功改善初级保健抑郁症的质量改善干预措施的许多组成部分。拟议的研究将患者的标准抑郁干预措施（由抑郁症患者提供）和医生（审查指南和结构化心理健康咨询）与患者中心的患者干预措施（患者激活，个人偏好和文化敏感性）和医生（将参与性沟通技巧培训与交互式CD-ROM的个人反馈培训）。 30名医生和250名患者将被随机分配给标准干预措施或文化量身定制的干预措施。主要的假设是，以患者为中心的文化量身定制干预组中的患者的抑郁症和12个月的抑郁症状水平较低，比标准干预护理组中的患者更高。次要结果将包括患者收到指南协和护理，患者和医师对护理的满意，患者 - 医师的沟通行为，患者和医师对抑郁症的态度以及管理抑郁症的自我效能感。这项研究将增加有关如何有效吸引非洲裔美国患者来护理抑郁症的知识，并作为如何将以患者为中心纳入计划的计划，以减少对共同状况的医疗保健中种族和种族差异的计划。