Adherence to Antidepressant Medication and Hypertension Treatment

坚持抗抑郁药物和高血压治疗

基本信息

批准号：
7990392
负责人：
HILLARY R BOGNER
金额：
$ 23.76万
依托单位：
UNIVERSITY OF PENNSYLVANIA
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：
2009-12-01 至 2012-11-30
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7990392
关键词：
Address Adherence Adult Adverse effects Affect Antidepressive Agents Antihypertensive Agents Atherosclerosis Blood Pressure Cardiovascular Diseases Cardiovascular system Caring Chronic Clinical effectiveness Comorbidity Congestive Heart Failure Consumption Coronary heart disease Country Data Development Diagnosis Diastolic blood pressure Disease remission Effectiveness Effectiveness of Interventions Elderly Endogenous depression Enrollment Evaluation Event Future Goals Grant Healthcare Heart Diseases Heavy Drinking Human Resources Hypertension Impaired cognition Intervention Lead Licensed Practical Nurse Life Style Longitudinal Studies Major Depressive Disorder Manic Medical Mental Depression Mental disorders Mentored Patient-Oriented Research Career Development Award Mentors Minority Modeling Monitor Moods Morbidity - disease rate Myocardial Infarction Myocardial Ischemia National Institute of Mental Health Obesity Outcome Participant Patients Persons Pharmaceutical Preparations Phase Physicians Play Positioning Attribute Prevalence Primary Care Physician Primary Health Care Process Psychosocial Stress Public Health Publishing Randomized Controlled Trials Recruitment Activity Reporting Research Research Project Grants Resources Risk Risk Factors Role Sampling Services Site Sodium Staging Strategic Planning Stroke Surveys Sympathetic Nervous System System Testing Time Training Tricyclic Antidepressive Agents United States Work World Health Organization aged behavior change blood pressure regulation cardiovascular disorder risk cardiovascular risk factor career development clinically significant comparative efficacy depressive symptoms design diabetic patient disability functional decline geriatric depression human old age (65+)hypertension control hypertension treatment improved innovation meetings mortality non-diabetic older patient patient oriented research physical conditioning primary care setting primary outcome programs protocol development psychosocial public health relevance research study response social suicide rate therapy design therapy development treatment as usual

项目摘要

DESCRIPTION (provided by applicant): This services R34 research study will provide important effectiveness pilot data to assess an intervention that includes a focus on adherence because poor adherence to depression treatment remains a significant impediment to improving care, in particular in the context of co morbid physical conditions such as hypertension. Training Licensed Practical Nurses (LPNs) who are already working in the practices to carry out the intervention will facilitate its deployment in real world practices with limited resources and competing demands. The primary aims of this proposal to be carried out in the primary care setting are: (1) Design an integrated intervention strategy to be carried out by LPNs who are already working in the practices to improve adherence to antidepressant treatment in the context of improving adherence to antihypertensive treatment for older primary care patients through integration of management of both depression and hypertension; (2) Test the feasibility and assess in a preliminary fashion the effectiveness of the integrated intervention strategy carried out by LPNs who are already working in the practices on the primary outcome of adherence to adequate antidepressant treatment by enrolling 100 adults aged 65 years and older with clinically significant depression and a systolic blood pressure (BP) > 140 mmHg or diastolic blood pressure (BP) > 90 mmHg for non-diabetics, or a systolic BP > 130 or a diastolic BP > 80 for diabetic patients. Exploratory outcomes that will be the primary outcomes of the future R01 will be depression response and remission, adherence to adequate antihypertensive treatment, and improved blood pressure control; and (3) Use data from this developmental study to develop an R01 for a full-scale randomized controlled trial of the intervention carried out by LPNs who are already working in the practices that integrates depression and hypertension management. The key components of the Integrated Care Intervention are: (1) integration of depression treatment with hypertension management; and (2) provision of an individualized program to improve adherence to antidepressant and antihypertensive medications that recognizes patients' social and cultural context. This project can have a significant public health impact because we are testing an integrated intervention to be carried out by Licensed Practical Nurses (LPNs) that may facilitate its deployment in real world practices with limited resources and competing demands. PUBLIC HEALTH RELEVANCE: The goal of this proposal which grows out of an NIMH Mentored Patient-Oriented Research Career Development (K23) Award is to integrate depression treatment into care for hypertension so that a single program can assist the patients with depression and hypertension. A depression intervention designed to address hypertension, a major factor for CVD, would provide a model for integration of depression treatment with care for other chronic medical conditions among older adults in primary care settings. This project can have a significant public health impact because we are testing an integrated intervention to be carried out by Licensed Practical Nurses (LPNs) that may facilitate its deployment in real world practices with limited resources and competing demands.

描述（由申请人提供）：此服务R34研究将提供重要的有效性试点数据，以评估关注依从性的干预措施，因为对抑郁症治疗的依从性不佳仍然是改善护理的重要障碍，尤其是在诸如高血压等CO病态的身体状况下。培训有执照的实践护士（LPN）已经从事进行干预的实践工作，将促进其在资源有限和竞争要求的现实世界实践中的部署。该提案在初级保健环境中进行的主要目的是：（1）设计一种综合的干预策略，由LPN进行的LPN旨在通过这种做法来提高抗抑郁治疗的依从性，以改善抑制抗性治疗的抗抑郁治疗，通过抑郁症和高压抑制和高压抑制的整合；（2）以初步的方式测试可行性和评估，LPN进行了综合干预策略的有效性，他们已经在遵守依从性的主要结果中从事实践的习惯，该策略是通过在65岁及65岁的临床抑郁症和临床上有明显的抑郁症和A a systoloct towrylow（BP）> 140 MMMH（BP）的65岁及以上的100名成年人来接受足够的抗抑郁治疗方法（BP）非糖尿病患者的非糖尿病药物或收缩压> 130或舒张压> 80。将来R01的主要结果的探索结果将是抑郁反应和缓解，遵守足够的降压治疗以及改善血压控制；（3）使用这项发展研究的数据来开发R01，以对LPN进行的干预措施进行全尺度随机对照试验，这些试验已经从事整合抑郁症和高血压管理的实践。综合护理干预的关键组成部分是：（1）将抑郁症治疗与高血压管理的整合；（2）提供一个个性化计划，以提高对抗抑郁药和抗高血压药物的依从性，以认可患者的社会和文化背景。该项目可能会产生重大的公共卫生影响，因为我们正在测试由执照的实践护士（LPN）进行的综合干预措施，该干预措施可能有助于其在资源有限和竞争要求的现实世界实践中的部署。公共卫生相关性：该提案的目标是从NIMH指导的以患者为导向的研究职业发展（K23）奖中提出的，旨在将抑郁症治疗纳入高血压护理中，以便一项计划可以帮助抑郁症和高血压患者。旨在解决高血压的抑郁症干预措施是CVD的主要因素，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。该项目可能会产生重大的公共卫生影响，因为我们正在测试由执照的实践护士（LPN）进行的综合干预措施，该干预措施可能有助于其在资源有限和竞争要求的现实世界实践中的部署。