Reducing Disparities and Improving Care for Depression in OB-GYN Clinics

减少妇产科诊所抑郁症的差异并改善护理

基本信息

批准号：
8079459
负责人：
WAYNE J KATON
金额：
$ 48.46万
依托单位：
UNIVERSITY OF WASHINGTON
依托单位国家：
美国
项目类别：
财政年份：
2009
资助国家：
美国
起止时间：
2009-08-01 至 2014-03-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8079459
关键词：
Adherence Adoption Affect Age Antidepressive Agents Appointment Attitude Blinded Brief Psychotherapy Caring Clinic Clinical Detection Diagnosis Disadvantaged Discipline of Nursing Dose Dysthymic Disorder Education Family Practice Female Goals Gynecologist Gynecology Internal Medicine Intervention Longevity Low income Major Depressive Disorder Menopause Mental Depression Mental Health Mental disorders Minority Modeling Monitor Odds Ratio Outcome Patients Perinatal Pharmaceutical Preparations Pregnancy Prevalence Primary Health Care Provider Public Health Quality of life Randomized Controlled Trials Reporting Research Research Design Research Personnel Resources Schedule Screening procedure Services Sex Characteristics Site Social Work Telephone Interviews Testing Time Training Treatment outcome Visit Woman Writing clinical care depressive symptoms diagnosis quality diagnostic accuracy functional outcomes improved male pregnant primary care setting public health relevance reproductive response routine care satisfaction sex single episode major depressive disorder treatment as usual treatment response

项目摘要

DESCRIPTION (provided by applicant): Background: Major depressive episodes occur throughout a woman's lifespan, with the highest rates during the reproductive and menopausal transition years. During this time, OB-GYNs are the only providers whom many women regularly see. Low income and minority women are particularly likely to seek their routine care in OB-GYN clinics. There are marked gaps in accuracy of diagnosis and quality of depression care in OB-GYN clinics, with disparities in quality of depression care which exceed those seen in primary care clinics. Models incorporating depression care into clinical settings may be adaptable to OB-GYN settings but have not been tested outside of the perinatal period. Most women seen by OB-GYNs are not pregnant; thus, studies focusing solely on perinatal depression excludes a large number of women who could benefit from care. No studies to date have been completed that have adapted depression care models to OB-GYN clinics as a whole. Research Goal: We propose a three-part intervention, integrated with OB-GYN care, consisting of (i) enhanced education; (ii) engagement; and (iii) depression care management (with antidepressant monitoring and/or provision of brief psychotherapy). We hypothesize that a three-part depression intervention, integrated into the OB-GYN clinical setting, will improve treatment outcomes for depression, functional outcomes, and satisfaction with depression care. Study Design: In the proposed randomized controlled trial, 260 OB-GYN clinic patients with major depression and/or dysthymia will be assigned to either: 1) an integrated depression intervention or 2) usual care (UC). We will screen approximately 8,300 patients presenting for scheduled clinic appointments at two urban OB-GYN clinics over 18-months for major depression/dysthymia. A large number of these patients are low-income and minority women. Potentially eligible patients may also be referred by a clinic provider or reply to informational flyers posted in the clinics. The integrated depression intervention will last 12 months. Outcomes will be assessed at baseline and at 6, 12, and 18 months by telephone interviews by blinded research staff. Aims: Our Primary Aims are: 1) To evaluate, compared to UC, the impact of an integrated OB-GYN depression intervention on depression treatment outcomes, including change in depressive symptoms and depression treatment response; and 2) To evaluate, compared to UC, the impact of an integrated OB-GYN depression intervention on functional outcomes. Our Secondary Aims are: 3) To evaluate, compared to UC, the impact of an integrated OB-GYN depression intervention on quality of depression care indicators, including number of therapy visits, and dose, duration, and adherence to antidepressant medications; and on satisfaction with depression care, including patient and provider satisfaction, and provider attitudes toward depression care in OB-GYN clinics; and 4) [To identify potential facilitators and barriers to sustainability of the integrated OB-GYN intervention.] PUBLIC HEALTH RELEVANCE: The results of our proposed randomized controlled trial will greatly impact public health by satisfying an unmet need for effective depression services for all women seen in the OB-GYN clinical setting. The potential improvements in depression treatment outcomes and quality of life for the large proportion of women who receive their care in this setting will be substantial.

描述（由申请人提供）：背景：重度抑郁发作发生在女性的整个一生中，在生育期和绝经过渡期发病率最高。在此期间，妇产科医生是许多女性经常去看望的唯一提供者。低收入和少数民族妇女特别有可能在妇产科诊所寻求常规护理。妇产科诊所的抑郁症诊断准确性和护理质量存在明显差距，抑郁症护理质量的差异超过了初级保健诊所的水平。将抑郁症护理纳入临床环境的模型可能适用于妇产科环境，但尚未在围产期之外进行过测试。大多数妇产科医生看诊的女性并未怀孕；因此，仅仅关注围产期抑郁症的研究将大量可以从护理中受益的妇女排除在外。迄今为止，尚未完成将抑郁症护理模式应用于整个妇产科诊所的研究。研究目标：我们提出了与妇产科护理相结合的三部分干预措施，包括（i）加强教育； (ii) 参与； (iii) 抑郁症护理管理（包括抗抑郁药监测和/或提供简短的心理治疗）。我们假设，将三部分抑郁症干预纳入妇产科临床环境中，将改善抑郁症的治疗结果、功能结果和对抑郁症护理的满意度。研究设计：在拟议的随机对照试验中，260 名患有重度抑郁症和/或心境恶劣的妇产科诊所患者将被分配到：1) 综合抑郁干预或 2) 常规护理 (UC)。我们将在 18 个月内对约 8,300 名在两家城市妇产科诊所预约就诊的重度抑郁症/心境恶劣患者进行筛查。这些患者中有很大一部分是低收入和少数民族妇女。潜在符合资格的患者也可能由诊所提供者转介或回复诊所张贴的信息传单。综合抑郁症干预将持续12个月。研究人员将通过电话访谈对基线以及第 6、12 和 18 个月的结果进行评估。目标：我们的主要目标是： 1) 与 UC 相比，评估综合妇产科抑郁干预对抑郁治疗结果的影响，包括抑郁症状的变化和抑郁治疗反应； 2) 与 UC 相比，评估综合妇产科抑郁干预对功能结果的影响。我们的次要目标是： 3) 与 UC 相比，评估综合妇产科抑郁症干预对抑郁症护理指标质量的影响，包括治疗就诊次数、剂量、持续时间和抗抑郁药物依从性；对抑郁症护理的满意度，包括患者和提供者的满意度以及提供者对妇产科诊所抑郁症护理的态度； 4) [确定综合妇产科干预措施可持续性的潜在促进因素和障碍。] 公共健康相关性：我们提出的随机对照试验的结果将极大地影响公共健康，因为它满足了妇产科临床环境中所有女性对有效抑郁症服务的未满足需求。对于在这种环境下接受护理的大部分女性来说，抑郁症治疗结果和生活质量的潜在改善将是巨大的。