Online Treatments for Mood and Anxiety Disorders in Primary Care

初级保健中情绪和焦虑症的在线治疗

基本信息

批准号：
8423688
负责人：
BRUCE Lawrence ROLLMAN
金额：
$ 59.91万
依托单位：
UNIVERSITY OF PITTSBURGH AT PITTSBURGH
依托单位国家：
美国
项目类别：
财政年份：
2012
资助国家：
美国
起止时间：
2012-02-09 至 2015-12-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8423688
关键词：
Adoption Age Anxiety Anxiety Disorders Attention Back Caring Case Manager Chronically Ill Clinical Clinical Research Clinical Trials Cognitive Therapy Computerized Medical Record Data Depressed mood Development Disease Effectiveness Enrollment Government Group Practice Healthcare Internet Intervention Intervention Studies Mails Maintenance Mediator of activation protein Medical Medical center Mental Depression Mental Health Methods Modeling Mood Disorders Moods Morbidity - disease rate Outcome Participant Patient Monitoring Patients Phase Primary Care Physician Primary Health Care Proliferating Protocols documentation Provider Randomized Reporting Research Personnel Resources SF-12 Subgroup Support Groups Symptoms System Testing United Kingdom Universities aged arm base collaborative care comparative effectiveness compare effectiveness computerized cost effectiveness effectiveness trial evidence base experience follow-up group intervention health care service utilization health related quality of life innovation medical specialties multidisciplinary patient oriented peer primary care setting programs randomized trial response skills telehealth treatment as usual web site

项目摘要

DESCRIPTION (provided by applicant): Depression and anxiety are prevalent in primary care practice, associated with substantial reductions in health-related quality of life (HRQoL), and generate a significant excess of morbidity. In response, dozens of trials have demonstrated the greater effectiveness of "Collaborative Care" for these conditions vs. primary care physicians' usual care. Yet for a variety of reasons, these models have not been widely implemented. Therefore, an urgent need remains to develop and test more scalable, powerful, and innovative versions of Collaborative Care while simultaneously developing a greater understanding of how best to provide these interventions through primary care where the majority of depressed and anxious patients seek treatment. Thousands of web sites provide medical information and the number of Internet support groups (ISG) where the public can exchange information about treatments is proliferating. Still, clinical trials have not established the benefits of utilizing he Internet in this manner. Concurrent with these developments, several computerized cognitive behavioral therapy (CCBT) programs have been proven effective at treating patients with mood and anxiety disorders and used by hundreds of thousands of patients outside the U.S. Yet CCBT remains little utilized inside the U.S., and no trials have incorporated CCBT into a Collaborative Care intervention or examined the effectiveness of combining CCBT with an ISG for these disorders. We propose a 4-year comparative effectiveness trial that will randomize 700 primary care patients aged 18-75 who have at least a moderate level of mood and/or anxiety symptoms and reliable access to both the Internet and e-mail to either: (1) guided patient access to Beating the Blues, a proven-effective on-line CCBT program (CCBT-alone; N=300); (2) guided patient access to Beating the Blues plus access to a moderated ISG (CCBT+ISG; N=300); or (3) their PCP's "usual care" (N=100). Our primary hypothesis is that patients in our CCBT+ISG arm will report a clinically meaningful 0.30 effect size (ES) or greater improvement in HRQoL on the SF-12 MCS compared to patients in our CCBT-alone arm at 6-months follow-up, and we will monitor patients for an additional 6 months to evaluate the durability of our interventions. Our secondary hypothesis is that CCBT-alone patients will report a 0.50 ES or greater improvement in HRQoL on the SF-12 MCS versus "usual care" at 6-months follow-up. To better understand how online mental health treatments are best provided through primary care, we will also evaluate: (a) their effectiveness across and within age strata; (b) their cost-effectiveness; (c) how patients utilize the components of our interventions; (d) patient subgroups for whom our interventions may be particularly effective; and (e) the adoption and maintenance of our interventions by practices following the Intervention Phase of the Project. Study findings are likely to have profound implications for transforming the way mental health conditions are treated in primary care and focus further attention to the emerging field of e-mental health by other U.S. investigators.

描述（由申请人提供）：抑郁和焦虑在初级保健实践中普遍存在，与健康相关的生活质量（HRQOL）大幅降低有关，并产生大量的发病率。作为回应，数十项试验表明，对于这些情况，“协作护理”与初级保健医生的通常护理的有效性更大。然而，由于多种原因，这些模型尚未得到广泛实施。因此，迫切需要开发和测试合作护理的更可扩展，强大和创新的版本，同时对如何通过大多数沮丧和焦虑的患者寻求治疗来最好地通过初级保健提供这些干预措施有更深入的了解。成千上万的网站提供医疗信息以及公众可以交换有关治疗信息的互联网支持小组（ISG）的数量正在激增。尽管如此，临床试验尚未确定以这种方式利用HE Internet的好处。与这些事态发展同时，几种计算机化的认知行为疗法（CCBT）计划已被证明有效地治疗患有情绪和焦虑症的患者，并被美国以外的数十万患者使用，但CCBT在美国境内仍未使用，并且没有试验的试验，没有试验。将CCBT纳入协作护理干预措施中，或检查了将CCBT与ISG相结合的这些疾病的有效性。我们提出了一项为期4年的比较有效性试验，该试验将对18-75岁的700名初级保健患者随机，他们至少具有中等水平的情绪和/或焦虑症状，并可靠地访问互联网和电子邮件至：（1））指导患者访问蓝调，这是一个可靠的在线CCBT计划（CCBT-OLONE; n = 300）；（2）指导患者访问蓝调，加上访问调节的ISG（CCBT+ISG; n = 300）;或（3）他们的PCP的“通常护理”（n = 100）。我们的主要假设是，与我们在6个月的随访中，与CCBT-12的患者相比，我们CCBT+ISG ARM中的患者将报告SF-12 MC的临床意义0.30效应大小（ES）或SF-12 MC的HRQOL的改善或更大的改善。，我们将再监测患者6个月以评估干预措施的耐用性。我们的次要假设是，CCBT的患者将在SF-12 MCS上报告0.50 ES的HRQOL在6个月的随访中与“常规护理”的HRQOL改善。为了更好地了解如何通过初级保健最好地提供在线心理健康治疗方法，我们还将评估：（a）它们在各个年龄阶层的有效性；（b）它们的成本效益；（c）患者如何利用干预措施的组成部分；（d）我们的干预措施可能特别有效的患者亚组；（e）通过项目的干预阶段，通过实践来采用和维护我们的干预措施。研究发现可能对改变基础护理中心理健康状况的方式有深远的影响，并将进一步关注其他美国调查人员关注电子健康健康领域。