Increasing Treatment Adherence in Co-Occurring Disorders

提高并发疾病的治疗依从性

基本信息

批准号：
7111800
负责人：
MICHAEL V PANTALON
金额：
$ 15.91万
依托单位：
YALE UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2002
资助国家：
美国
起止时间：
2002-09-25 至 2007-08-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7111800
关键词：
behavior modification behavior therapy behavioral /social science research tag clinical depression clinical research clinical trials combination therapy comorbidity computer assisted patient care drug /alcohol abstinence drug abuse human therapy evaluation mental health counseling motivation outcomes research patient oriented research therapy compliance

项目摘要

DESCRIPTION: (Provided by Applicant): This application is for a "Mentored Patient-Oriented Research Career Development Award" (K23) to study treatment adherence in co-occurring psychiatric and drug use disorders (COD), under the mentorship of Bruce J. Rounsaville, M.D. and Richard S. Schottenfeld, M.D. Nonadherence is a critical issue in COD, especially among those with depressive disorders, as it occurs frequently and limits the maximal benefit achieved by efficacious treatments, particularly those with the potential to improve both conditions (e.g., antidepressants). Therefore, adherence-enhancing interventions for COD can optimize the efficacy of treatments. They are also adaptable to new treatments that are being developed. While preliminary studies indicate that adherence-enhancing interventions are efficacious for patients with non-COD, little systematic evaluation has occurred in COD. Compared to developing new contents for treatment, studying brief strategies to improve adherence to existing treatments is a highly cost-efficient approach that can have a large and rapid payoff. The research plan for this K23 application entails: 1) the evaluation of adherence issues in 9 ongoing studies and 2) completion of a new clinical trial evaluating innovative adherence-enhancing methods for COD in a dual-diagnosis outpatient clinic. This new clinical trial will employ a dismantling design, within which 75 outpatients with co-occurring depressive disorders and drug abuse/dependence (CODDA) will be randomly assigned to: 1) Treatment-as-Usual (TAU), a control condition offering medication management, standard education regarding diagnosis and the importance of adherence, and group counseling, 2) TAU+Adherence Feedback (TAU+AF), in which patients receive TAU plus computerized feedback on medication and counseling adherence, based on Medication Event Monitoring System (MEMS; Aprex Corporation, Fremont, CA) data and attendance records, or 3) TAU+Motivationally Enhanced Feedback (TAU+MEF), in which TAU plus Motivational Enhancement Therapy and Contingency Management will be added to AF. Primary outcome measures are: 1) rates of adherence to antidepressant medication, as measured by MEMS caps and self-report, 2) rates of counseling attendance, and 3) reductions in illicit drug use, including achievement of abstinence, as assessed by twice-weekly urine toxicology tests and self-report. Secondary outcomes include reductions in depressive symptomatology and rates of re-hospitalization.

描述：（申请人提供）：此应用是针对“受到患者为导向的研究职业的” 开发奖（K23），以研究同时存在的治疗依从性在Bruce J.的指导下，精神病和药物使用障碍（COD）（COD）医学博士Rounsaville和M.D. Richard S. Schottenfeld不遵守是关键鳕鱼中的问题，尤其是在患有抑郁症的人中经常限制有效治疗所带来的最大利益，特别是那些有潜力改善这两种情况的人（例如，抗抑郁药）。因此，对鳕鱼的依从性增强干预措施可以优化治疗的功效。他们也适合新治疗正在开发。而初步研究表明依从性的干预措施对于非COD患者有效， COD中很少发生系统评估。与开发新的用于治疗的内容，研究简短的策略以提高依从性现有治疗是一种高度成本效益的方法，可以具有较大的方法和快速的回报。该K23申请的研究计划需要：1）评估9项正在进行的研究和2）完成新的依从性问题临床试验评估COD的创新依从性增强方法双诊断门诊诊所。这项新的临床试验将采用拆卸设计，其中75名门诊患者同时发生抑郁症疾病和药物滥用/依赖（CODDA）将随机分配给：1）治疗与普遍（TAU），一种提供药物管理的控制条件，有关诊断和依从性的重要性的标准教育以及小组咨询，2）tau+依从性反馈（tau+AF），患者接受 tau加上有关药物和咨询依从性的计算机反馈，基于用药事件监控系统（MEMS； APREX Corporation，Fremont，CA）数据和出勤记录，或3）tau+动机增强反馈（TAU+MEF）， tau加动力增强疗法和应急管理将添加到AF。主要结果指标是：1）遵守率通过MEMS CAPS和自我报告测量的抗抑郁药，2）速率咨询出勤和3）减少非法药物使用，包括通过两次每周两次尿毒理学测试评估，禁欲的实现和自我报告。次要结果包括抑郁症的减少症状和重新院长的速度。