Web-Based Program to Improve Antidepressant Medication Adherence

基于网络的提高抗抑郁药物依从性的计划

• 批准号: 8199748
• 负责人: REBEKAH K HERSCH
• 金额: $ 14.97万
• 依托单位: ISA ASSOCIATES, INC.
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-09-15 至 2012-12-14
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8199748
• 关键词: 18 year old; Address; Adherence; Adult; Adverse effects; Affect; Age; American; Antidepressive Agents; Anxiety; Appointment; Behavioral Sciences; Benchmarking; Bipolar Disorder; Clinical; Collaborations; Communication; Complex; Counseling; Country; Data; Dependence; Development; Diagnosis; Disease; Dysthymic Disorder; Family; Fright; Goals; Guidelines; Health; Healthcare; Income; Individual; Instruction; Internet; Intervention; Interview; Knowledge; Life; Major Depressive Disorder; Manuals; Measures; Medical center; Mental Depression; Mental Health; Mental disorders; Methods; Modeling; Mood Disorders; Moods; Nature; Online Systems; Oral; Outcome; Outcome Measure; Participant; Patient Self-Report; Patients; Pharmaceutical Preparations; Pharmacy facility; Phase; Physicians; Population; Prevention program; Problem Solving; Productivity; Program Development; Psychiatry; Psychology; Randomized; Randomized Controlled Trials; Relapse; Relative (related person); Research; Risk; Role; Sampling; Self Efficacy; Stress; Surveys; Telephone; Testing; Time; Treatment Effectiveness; Treatment Protocols; Universities; Washington; Work; Writing; base; behavioral health; burden of illness; collaborative care; compliance behavior; coping; cost; design; disability; disability-adjusted life years; dosage; health care service utilization; improved; innovation; medical schools; medication compliance; meetings; member; misuse of prescription only drugs; outreach; pill; professor; programs; prototype

DESCRIPTION (provided by applicant): Mood disorders, including major depressive disorder, dysthymia, and bipolar disorder, affect nearly 21 million Americans or 9.5% of the U.S. population age 18 years of age and older. Among mental health problems, major depressive disorder is the leading cause of disability in the U.S. for people ages 15-44, affecting nearly 15 million adults each year. While research has clearly shown the efficacy of antidepressant medication for treating major depression when medications are taken in accordance with national guidelines, that efficacy is compromised when patients do not take medications as prescribed. Estimates for non-adherence to antidepressant medications range from 20% to 59%. Reasons for non-adherence range from adverse side effects, clinical improvement prior to completing treatment course, fear of dependence, discomfort with taking psychotropic medications, lack of treatment effectiveness, and desire to solve problems without drugs. Many interventions have been implemented in an attempt to improve patient adherence to treatment regimens, but the most effective programs are often are often complex and labor intensive leading McDonald and her colleagues to conclude that more studies of innovative methods are needed. ISA Associates, in partnership with Aetna Behavioral Health Care and the Redmon Group, proposes to develop and pilot test a prototype web-based antidepressant medication adherence program, Life Steps for Depression, for individuals diagnosed with major depressive disorder and prescribed antidepressant medication. The prototype will be based on Safren's successful Life Steps medication adherence approach. Once the prototype is developed, it will be pilot tested with a sample of 60 Aetna Behavioral Health members who are newly prescribed antidepressant medication and have a corresponding diagnosis of major depressive disorder. Because of the limited nature of the prototype, in which only a sample of the final program content will be fully developed, feasibility will be based on self-reported outcome measures related to the prototype content. These measures will include knowledge of depression, medications, and adherence; perceived efficacy in patient-physician interactions; coping with side effects; medication adherence self-efficacy; [and medication adherence]. Participants will complete the survey at baseline and two months. Phase I milestones and benchmarks for proceeding to Phase II are described. If shown effective, the web-based Life Steps for Depression would be available to all individuals prescribed antidepressant medications for depression with access to the Internet, greatly expanding the reach of medication adherence programs. The proposed research team including Drs. Hersch and Billings have successfully created and tested several web-based behavioral health programs, including Smart Rx (a prescription drug misuse prevention program) and Stress and Mood Management (which addresses stress, depression, anxiety, and treatments that work). Drs. Hersch and Billings will be assisted by Dr. Steve Safren, Associate Professor in Psychology, Harvard Medical School and developer of the Life Steps approach, and Dr. Wayne Katon, Professor of Psychiatry and Vice Chair of the Department of Psychiatry and Behavioral Sciences at the University of Washington Medical Center. PUBLIC HEALTH RELEVANCE: Clinical evidence now shows that there are safe and effective antidepressant medications that can be used to treat major depressive disorder. However, many individuals fail to complete the minimum recommended six month treatment regimen for a wide variety of reason. Recent data suggests that there are collaborative care and telephone outreach approaches that can increase medication compliance and improve clinical outcomes. Unfortunately, the reach of these interventions is limited by their cost and relative inaccessibility. The outcome of this Phase I project will be a prototype of an innovative, web-based medication adherence program for individuals diagnosed with major depressive disorder who are being treated with antidepressant medications. Such a program, if effective, will greatly expand access to an effective medication adherence program, thereby improving the clinical outcomes of people with depression and reducing the likelihood of depression relapse.

描述（由申请人提供）：情绪障碍，包括重度抑郁症、心境恶劣和双相情感障碍，影响着近 2100 万美国人，即 18 岁及以上美国人口的 9.5%。在心理健康问题中，重度抑郁症是美国 15-44 岁人群残疾的主要原因，每年影响近 1500 万成年人。虽然研究清楚地表明，按照国家指南服用抗抑郁药物治疗重度抑郁症的疗效，但如果患者不按处方服用药物，其疗效就会受到影响。据估计，不坚持服用抗抑郁药物的比例为 20% 至 59%。不依从的原因包括不良副作用、完成治疗过程之前的临床改善、对依赖性的恐惧、服用精神药物的不适、缺乏治疗效果以及希望不通过药物解决问题。为了提高患者对治疗方案的依从性，已经实施了许多干预措施，但最有效的方案往往是复杂且劳动密集型的，导致麦克唐纳和她的同事得出结论，需要对创新方法进行更多研究。 ISA Associates 与 Aetna Behavioural Health Care 和 Redmon Group 合作，提议为被诊断患有重度抑郁症并服用抗抑郁药物的个人开发并试点测试基于网络的抗抑郁药物依从性计划原型“Life Steps for Depression”。该原型将基于 Safren 成功的 Life Steps 药物依从方法。原型开发完成后，将以 60 名 Aetna 行为健康成员为样本进行试点测试，这些成员新开了抗抑郁药物，并有相应的重度抑郁症诊断。由于原型的有限性，其中仅会完全开发最终程序内容的样本，因此可行性将基于与原型内容相关的自我报告的成果衡量。这些措施将包括抑郁症知识、药物治疗和依从性；患者与医生互动中的感知功效；应对副作用；药物依从性自我效能感； [和药物依从性]。参与者将在基线和两个月内完成调查。描述了第一阶段的里程碑和进入第二阶段的基准。如果证明有效，基于网络的“抑郁症生活步骤”将向所有服用抗抑郁药物治疗抑郁症的人开放，并可通过互联网访问，从而极大地扩大药物依从性计划的覆盖范围。拟议的研究团队包括博士。 Hersch 和 Billings 成功创建并测试了多个基于网络的行为健康计划，包括 Smart Rx（处方药滥用预防计划）和压力和情绪管理（解决压力、抑郁、焦虑和有效的治疗方法）。博士。 Hersch 和 Billings 将得到哈佛医学院心理学副教授、生命步骤方法开发者 Steve Safren 博士，以及哈佛医学院精神病学教授兼精神病学和行为科学系副主席 Wayne Katon 博士的协助。华盛顿大学医学中心。 公共卫生相关性：现在的临床证据表明，有安全有效的抗抑郁药物可用于治疗重度抑郁症。然而，许多人由于各种原因未能完成推荐的最低六个月治疗方案。最近的数据表明，协作护理和电话外展方法可以提高用药依从性并改善临床结果。不幸的是，这些干预措施的范围因其成本和相对难以获得而受到限制。该第一阶段项目的成果将是一个创新的、基于网络的药物依从性计划的原型，该计划针对被诊断患有重度抑郁症并正在接受抗抑郁药物治疗的个人。这样的计划如果有效，将极大地扩大获得有效药物依从计划的机会，从而改善抑郁症患者的临床结果并降低抑郁症复发的可能性。