Patient-Centered Depression Care in the Public Sector

公共部门以患者为中心的抑郁症护理

• 批准号: 6941240
• 负责人: ISABEL TERESA LAGOMASINO
• 金额: $ 68.84万
• 依托单位: UNIVERSITY OF SOUTHERN CALIFORNIA
• 依托单位国家: 美国
• 财政年份: 2004
• 资助国家: 美国
• 起止时间: 2004-09-01 至 2008-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6941240
• 关键词: Hispanic Americans; antidepressants; behavior therapy; clinical depression; clinical research; community health services; counseling; health care policy; health care service evaluation; health care service utilization; health disparity; human subject; human therapy evaluation; managed care; medically underserved population; mental disorder chemotherapy; patient care management; patient care personnel relations; patient care planning; preference; psychotherapy; socioeconomics

DESCRIPTION (provided by applicant): For depression care to be sustainable in public sector primary care settings, it must accommodate patient preferences and the priorities and capacities of providers and administrators. This application aims to directly address the need for information on how to assess and incorporate the preferences of patients, providers, and administrators into the design of a depression intervention. In 3 large public sector primary care centers serving mostly low-income Latinos, we assess the depression care preferences and resources of patients, providers, and administrators. To do so, we use mixed qualitative and quantitative methods and a novel application of conjoint analysis, a marketing research method. Next, we randomize 100 patients at each clinic (300 patients total) to a standardized depression intervention vs. wait list control, not for the traditional purpose of studying intervention effects on patient outcomes, but rather for providing patients, clinicians, and administrators with a treatment exposure. We then examine whether stated preferences before the intervention correspond to the actual behaviors of patients, providers, and administrators when provided with an opportunity for care, and whether exposure to depression treatment or improved outcomes change stated preferences for care. Finally, we conduct a multi-stakeholder negotiation process to prioritize consumer oriented- preferences for care given resource constraints. At study end, we will have gained information regarding the preferences of multiple stakeholders in public sector care and on how public primary care systems can weigh not only the often harsh realities of public sector practice constraints, but also the needs and priorities of informed consumers, in efforts to improve care.

描述（由申请人提供）：为了使抑郁症护理在公共部门初级保健环境中保持可持续，它必须适应患者的偏好以及提供者和管理人员的优先事项和能力。该应用程序旨在直接解决有关如何评估和纳入患者，提供者和管理人员的偏好纳入抑郁干预措施的需求的需求。在大多数低收入拉丁裔的3个大型公共部门初级保健中心中，我们评估了患者，提供者和管理人员的抑郁症护理偏好和资源。为此，我们使用混合的定性和定量方法以及一种营销研究方法的联合分析的新应用。接下来，我们将每个诊所的100名患者（总计300名患者）随机，以进行标准化的抑郁干预措施与等待名单控制，而不是为了研究干预对患者预后的影响，而是为了为患者，临床医生和管理人员提供治疗暴露。然后，我们检查干预之前所陈述的偏好是否对应于患者，提供者和管理人员的实际行为，并在提供护理的机会时是否对应于患者，提供者和管理人员的实际行为，以及是否接受抑郁症治疗或改善的结果，是否会改变陈述的护理偏好。最后，我们进行了一个多利益相关者的谈判过程，以优先考虑给定资源限制的护理偏好。在研究结束时，我们将获得有关公共部门护理中多个利益相关者的偏好的信息，以及公共医疗系统如何权衡公共部门实践限制的经常严厉现实，还可以权衡知情消费者的需求和优先事项，以改善护理。