Understanding Prescription Decisions in Schizophrenia

了解精神分裂症的处方决定

• 批准号: 7211460
• 负责人: JULIE A. KREYENBUHL
• 金额: $ 14.33万
• 依托单位: UNIVERSITY OF MARYLAND BALTIMORE
• 依托单位国家: 美国
• 财政年份: 2003
• 资助国家: 美国
• 起止时间: 2003-04-01 至 2009-11-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7211460
• 关键词: Adopted; Adverse effects; Affect; Anti-Anxiety Agents; Antipsychotic Agents; Behavior; Board Certification; Characteristics; Clinical; Clinical Psychology; Clozapine; Cognitive; Complex; Country; Data; Decision Making; Development; Educational Intervention; Effectiveness; Evaluation; Evidence based treatment; Faculty; Family; Funding; Geographic Locations; Goals; Grant; Health Services Research; Individual; Influentials; Inpatients; Knowledge; Medication Management; Mental Health Services; Mentored Research Scientist Development Award; Mentors; Mood stabilizers; Motivation; National Institute of Mental Health; Numbers; Outcome; Outpatients; Patients; Pattern; Persons; Pharmaceutical Preparations; Pharmacologic Substance; Polypharmacy; Prevalence; Prisoner; Process; Psychiatrist; Psychiatry; Psychopharmacology; Range; Relative (related person); Research; Research Project Grants; Research Training; Role; Sampling; Schizophrenia; Side; Survey Methodology; Training Activity; Treatment Protocols; United States Department of Veterans Affairs; Veterans; behavior influence; career; dosage; improved; member; preference; prescription document; prescription procedure; programs; psychopharmacologic agent; severe mental illness; therapy design; therapy development; willingness

DESCRIPTION (provided by candidate): This revised application outlines an integrated training and research program for a NIMH K01 Mentored Research Scientist Development Award. My long-term career goal is to develop a program of research focused on medication effectiveness in individuals with serious mental illnesses (SMI) that includes investigating the process and outcomes of medication prescription in typical clinical practice settings, and applying this knowledge to the design of interventions to improve medication prescription decisions. My immediate career goal is to understand the prescription of complex, multi-drug regimens ('polypharmacy') in schizophrenia, focusing specifically on combination antipsychotic regimens in this application. Both clinician-related ('supply-side') and patient and family-related ('demand-side') factors, which are equally important and influential forces affecting medication management decisions will be considered. To achieve these goals, I will complete didactic coursework and mentored training activities concurrently with research projects that focus on prescription decision-making, anti-psychotic polypharmacy, and survey methods, as well as the development of interventions to improve prescription decisions in schizophrenia. These activities will be conducted under the guidance of several faculty members from across the country with expertise in mental health services research, psychopharmacology, and both cognitive and clinical psychology. A research plan of four projects is proposed. The first study will use Veterans Administration administrative encounter data to examine the prevalence and correlates of prescription of multiple antipsychotic medications in schizophrenia. This data will permit the evaluation of prescribing patterns across a range of inpatient and outpatient facilities covering a vast geographic area. The second and third studies will be conducted in conjunction with two funded NIMH R01 grants. One project will evaluate the modifiable clinician characteristics/behaviors that influence prescription decisions regarding combined antipsychotic regimens in a nation-wide sample of psychiatrists. The new third research project will examine the willingness of psychiatrists to adopt evidence-based treatments for schizophrenia and their preferences for various formats for educational interventions. The fourth study expands the evaluation of prescription decision-making in schizophrenia by focusing on the roles of both the patient and the family in this process. Understanding the patient, clinician, and treatment setting factors that are correlated with antipsychotic polypharmacy, while also uncovering aspects of the cognitive processes involved in prescription decision-making that may be modifiable, will inform the subsequent development of an R01 application aimed at improving the process of prescription decision-making for persons with schizophrenia.

描述（由候选人提供）：此修订的应用程序概述了NIMH K01指导研究科学家发展奖的综合培训和研究计划。我的长期职业目标是制定一项研究计划，重点是严重精神疾病（SMI）的药物效率（SMI），其中包括调查典型临床实践环境中的药物处方的过程和结果，并将此知识应用于设计改善药物处方决策的干预措施。我的直接职业目标是了解精神分裂症中复杂的多药方案（“多药”）的处方，专门针对本应用程序中的抗精神病药组合。将考虑与临床医生有关的（“供应方”）以及患者和家庭有关的（“需求方”）因素，这些因素将同样重要，影响了影响药物管理决策的有影响力的力量。为了实现这些目标，我将完成教学课程和指导的培训活动，同时与研究项目有关，这些项目的重点是处方决策，反精神病性多药和调查方法，以及开发改善精神分裂症处方决策的干预措施。这些活动将在全国各地的几位教职员工的指导下进行，具有精神卫生服务研究，心理药理学以及认知和临床心理学的专业知识。提出了四个项目的研究计划。第一项研究将使用退伍军人管理行政遭遇数据来检查精神分裂症多种抗精神病药的处方的患病率和相关性。该数据将允许评估涵盖庞大地理区域的一系列住院和门诊设施的处方模式。第二和第三研究将与两个资助的NIMH R01赠款一起进行。一个项目将评估可改变的临床医生特征/行为，这些特征/行为会影响全国性精神病医生样本中抗精神病药综合方案的处方决策。新的第三项研究项目将研究精神科医生对精神分裂症采用循证治疗的意愿及其对各种教育干预措施的偏好。第四项研究通过关注患者和家庭在此过程中的作用，扩大了精神分裂症的处方决策的评估。了解与抗精神病药多药相关的患者，临床医生和治疗设置因素，同时还发现可能修改处方决策所涉及的认知过程的各个方面，将为随后的R01应用程序提供旨在改善该过程的R01的开发精神分裂症患者的处方决策。

项目成果

Does Adherence to Medications for Type 2 Diabetes Differ Between Individuals With Vs Without Schizophrenia?

• DOI: 10.1093/schbul/sbn106
• 发表时间: 2010-03-01
• 期刊: SCHIZOPHRENIA BULLETIN
• 影响因子: 6.6
• 作者: Kreyenbuhl, Julie;Dixon, Lisa B.;Valenstein, Marcia
• 通讯作者: Valenstein, Marcia

Long-term antipsychotic polypharmacy in the VA health system: patient characteristics and treatment patterns.

退伍军人事务部卫生系统中的长期抗精神病药物多药治疗：患者特征和治疗模式。

• DOI: 10.1176/ps.2007.58.4.489
• 发表时间: 2007
• 期刊: Psychiatric services (Washington, D.C.)
• 作者: Kreyenbuhl,JulieA;Valenstein,Marcia;McCarthy,JohnF;Ganoczy,Dara;Blow,FredericC
• 通讯作者: Blow,FredericC

Care and management of cardiovascular risk factors among individuals with schizophrenia and type 2 diabetes who smoke.

吸烟的精神分裂症和 2 型糖尿病患者心血管危险因素的护理和管理。

• DOI: 10.1016/j.genhosppsych.2008.07.007
• 发表时间: 2009
• 期刊: General hospital psychiatry
• 影响因子: 7
• 作者: Himelhoch,Seth;Leith,Jaclyn;Goldberg,Richard;Kreyenbuhl,Julie;Medoff,Deborah;Dixon,Lisa
• 通讯作者: Dixon,Lisa

Physical wellness and employment status among adults with serious mental illness.

患有严重精神疾病的成年人的身体健康和就业状况。

• DOI: 10.1007/s10597-008-9124-0
• 发表时间: 2008
• 期刊: Community mental health journal
• 影响因子: 2.7
• 作者: Goldberg,RichardW;Hackman,Ann;Medoff,DeborahR;Brown,Clayton;Fang,LiJuan;Dickerson,Faith;Kreyenbuhl,Julie;Dixon,Lisa
• 通讯作者: Dixon,Lisa

Quality of diabetes care among adults with serious mental illness.

患有严重精神疾病的成年人的糖尿病护理质量。

• DOI: 10.1176/ps.2007.58.4.536
• 发表时间: 2007
• 期刊: Psychiatric services (Washington, D.C.)
• 作者: Goldberg,RichardW;Kreyenbuhl,JulieA;Medoff,DeborahR;Dickerson,FaithB;Wohlheiter,Karen;Fang,LiJuan;Brown,ClaytonH;Dixon,LisaB
• 通讯作者: Dixon,LisaB