Adherence to Depression Treatment Among Older Patients

老年患者对抑郁症治疗的依从性

• 批准号: 7015074
• 负责人: HILLARY R BOGNER
• 金额: $ 17.6万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2003
• 资助国家: 美国
• 起止时间: 2003-02-20 至 2008-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7015074
• 关键词: behavior therapy; cardiovascular disorder; clinical research; cognition; comorbidity; depression; human subject; human therapy evaluation; interview; patient oriented research; psychiatric patient care

This application for an NIMH Mentored Patient-Oriented Research Career Development Award (K23 Award) seeks support to develop a program of research related to the treatment of depression in older adults with cardiovascular disease (CVD). This application capitalizes on my background in family medicine and clinical epidemiology and proposes activities aimed at developing my ability to design, implement, and evaluate interventions directed at the treatment of depression in older primary care patients with CVD. An intervention for depression designed to address CVD comorbidity would provide a model for integration of depression treatment with care for other chronic medical conditions among older adults in the primary care setting. My knowledge of clinical family medicine, epidemiology, and biostatistics, as well as my experience of implementing a large primary care-based study provide an excellent background for development as an intervention researcher. The University of Pennsylvania offers an outstanding research environment to help accomplish the goals of this K23: (1) to study the patient characteristics that place older adults with depression and CVD at risk for nonadherence to depression treatment; (2) to obtain expertise in advanced statistical methods, e.g. structural equation models and new study designs, both of which are integral to my study of adherence in primary care settings; and, (3) to design interventions for depression among older primary care patients with CVD. In addition to educational activities, this application lays out a research plan unfolding in three phases. Phase I will examine factors associated with adherence to recommended depression therapy in older primary care patients with CVD in an NIMH-funded study designed to test the effectiveness of an intervention aimed at improving the recognition and treatment of depression (the PROSPECT study). The focus will be on how cardiovascular comorbidity, executive and cognitive functioning, beliefs about depression and its treatment, social support, and other patient-level factors are associated with adherence to depression treatment in older primary care patients. In Phase 2, semi-structured interviews of older primary care patients will explore patient concepts of depression in relation to CVD and its treatment and patient preferences for possible strategies aimed at improving adherence to depression treatment. Phase 3 will test the feasibility of a protocol for an intervention aimed at the treatment of older adults with CVD. The protocol will be based on the results from Phases 1 and 2. During Phase 4, the findings from Phases 1, 2, and 3 will guide the final development of an R01 intervention study, sketched out in the final section of this K23. This project will set the stage for the development and implementation of interventions to improve depression treatment adherence among persons with co-existing CVD.

该申请是NIMH指导的以患者为导向的研究职业发展奖（K23奖）寻求支持，以制定与心血管疾病（CVD）老年人治疗抑郁症有关的研究计划。该应用程序利用了我在家庭医学和临床流行病学方面的背景，并提出了旨在发展我设计，实施和评估针对该干预措施的能力的活动 CVD较老的初级保健患者的抑郁症治疗。旨在解决CVD合并症的抑郁症干预措施将为抑郁症治疗与初级保健环境中老年人的其他慢性医疗状况的护理相结合提供模型。我对临床家庭医学，流行病学和生物统计学的了解，以及我实施大型初级保健研究的经验，提供了一个很好的 作为干预研究人员发展的背景。宾夕法尼亚大学提供了一个出色的研究环境，以帮助实现这一K23的目标：（1）研究将抑郁症的老年人和CVD面临不遵守抑郁症治疗风险的患者特征； （2）获得高级统计方法的专业知识，例如结构方程模型和新研究设计，这都是我对我研究的不可或缺的一部分 在初级保健环境中的依从性； （3）在CVD患者中设计抑郁症的干预措施。除了教育活动外，该应用程序还规定了一个研究计划，该计划分为三个阶段。第一阶段将研究与NIMH资助的一项旨在测试旨在改善干预措施的有效性的CVD老年医疗患者建议抑郁疗法有关的因素 抑郁症的识别和治疗（前景研究）。重点将放在心血管合并症，执行和认知功能，对抑郁及其治疗，社会支持以及其他患者水平因素的信念与较老的初级保健患者的抑郁症治疗有关。在第2阶段，年龄较大的初级保健患者的半结构化访谈将探讨患者与CVD及其有关 治疗和患者偏好的旨在改善依从性抑郁症治疗的策略。第三阶段将测试针对CVD老年人治疗的干预措施方案的可行性。该协议将基于第1阶段和第2阶段的结果，在第4阶段，第1、2和3阶段的发现将指导在本k23最后一部分中概述的R01干预研究的最终发展。这个项目将设置 开发和实施干预措施，以改善共存CVD的人之间的抑郁症治疗依从性。