Alliance and Mechanisms of Medication Adherence in Pediatric Psychiatric Practice

儿科精神病学实践中药物依从性的联盟和机制

基本信息

批准号：
8596004
负责人：
Alessandro Stevens De Nadai
金额：
$ 3.44万
依托单位：
UNIVERSITY OF SOUTH FLORIDA
依托单位国家：
美国
项目类别：
财政年份：
2013
资助国家：
美国
起止时间：
2013-09-09 至 2015-09-08
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8596004
关键词：
Accounting Address Adherence Adolescent Adverse effects Affect Alcohol or Other Drugs use Ally American Antidepressive Agents Anxiety Attitude Behavioral Mechanisms Belief Child Childhood Commit Communication Consultations Data Educational Curriculum Evidence based intervention Feedback Fellowship Fostering Funding Future Goals Health Health Personnel Healthcare Hospitals Individual Instruction Intervention Investigation Lead Literature Mediating Mediation Medical Mental Depression Mentors Mind Modeling National Institute of Mental Health Nature Outcome Outcome Assessment Outpatients Parents Pathway interactions Patient Care Patient Self-Report Patients Pharmaceutical Preparations Pharmacotherapy Pharmacy facility Provider Psychiatric therapeutic procedure Psychiatry Psychopathology Psychotherapy Quality of life Records Relapse Reporting Research Research Personnel Resources Risk Role Safety Series Suicide Surgeon Therapeutic Therapeutic Effect Time Training Treatment Effectiveness Treatment outcome Work Youth community based care functional disability improved medication compliance multi-component intervention neglect prevent public health relevance skills training

项目摘要

DESCRIPTION (provided by applicant): Psychiatric medications have been established as an efficacious treatment for pediatric anxiety and depression, with approximately 60% of youth responding to pharmacotherapy alone and over 75% responding to multimodal intervention (March et al., 2004, Walkup et al., 2008). However, recent research has indicated that medication adherence for these conditions is suboptimal, with over 50% of children discontinuing treatment before the period recommended for full therapeutic benefit (Murray et al., 2004; Richardson et al., 2004). This is highly troubling given that these conditions are relatively common and highly debilitating psychiatric conditions, which are associated with substantial functional impairment, reduced quality of life, and suicidality (Langley et al, 2004, Puig-Antich et al., 1993; US Surgeon General, 1999). Moreover, poor adherence may have a widespread effect on treatment effectiveness for these conditions, as an estimated 2.6% of American children receive antidepressant medication in a given year (Olfson & Marcus, 2009). Unfortunately, relatively few empirical data exist about variables that may relate to medication adherence in pediatric anxiety and depression. With this in mind, the goal of the proposed investigation is to examine potential mechanisms of such adherence, with a particular focus on the therapeutic alliance (Shirk & Karver, 2003). Indeed, children and parents who do not feel a bond with the clinician, agree with the clinician on tasks to be performed in treatment, or have unrealistic goals for outcome may be less likely to continue pharmacotherapy in the face of side effects and inconvenience. Adolescent psychiatric outpatients (N=150) as well as their parents and clinicians will be evaluated through self-reports and tracking of pharmacy records to evaluate the role of therapeutic alliance and other behavioral mechanisms of medication adherence. Additionally, this fellowship will provide training to the applicant to prepare him to become an independent, externally funded investigator through a series of personalized activities (including additional coursework, didactic activities, and direct mentoring and consultation). Potential implications of this research are multifaceted. First, future research would need to be focused on developing evidence-based interventions to improve alliance (e.g., communications skills training for the working alliance; Meystre et al., 2012). Second, training curricula of medical personnel (e.g., psychiatry residents) would be indicated to include instruction in developing a therapeutic alliance. Third, identifying these mechanisms could assist in creating an idiographic approach to patient care, where specific interventions to improve medication adherence are employed only for patients who may need them. Thus, the proposed research has wide-ranging implications for future research and the training of medical personnel.

描述（由申请人提供）：精神科药物已被确定为治疗儿科焦虑和抑郁的有效方法，大约 60% 的青少年对单独药物治疗有反应，超过 75% 对多模式干预有反应（March 等人，2004 年，Walkup 等人）等，2008）。然而，最近的研究表明，这些病症的药物依从性并不理想，超过 50% 的儿童在建议获得完全治疗效果的时期之前停止治疗（Murray 等人，2004 年；Richardson 等人，2004 年）。这是非常令人不安的，因为这些疾病是相对常见和高度衰弱的精神疾病，与严重的功能障碍、生活质量下降和自杀有关（Langley 等，2004；Puig-Antich 等，1993；US Surgeon将军，1999）。此外，依从性差可能会对这些疾病的治疗效果产生广泛影响，因为估计有 2.6% 的美国儿童在某一年接受抗抑郁药物治疗（Olfson & Marcus，2009）。不幸的是，关于可能与儿科焦虑和抑郁药物依从性相关的变量的经验数据相对较少。考虑到这一点，拟议研究的目标是检查这种依从性的潜在机制，特别关注治疗联盟（Shirk & Karver，2003）。事实上，如果儿童和家长感觉与临床医生没有联系、不同意临床医生在治疗中要执行的任务，或者对结果有不切实际的目标，那么面对副作用和不便，他们可能不太可能继续药物治疗。将通过自我报告和药房记录跟踪对青少年精神科门诊患者（N = 150）及其父母和临床医生进行评估，以评估治疗联盟的作用和药物依从性的其他行为机制。此外，该奖学金还将为申请人提供培训，通过一系列个性化活动（包括额外的课程作业、教学活动以及直接指导和咨询），帮助他做好成为一名独立的、外部资助的研究者的准备。这项研究的潜在影响是多方面的。首先，未来的研究需要集中于开发基于证据的干预措施以改善联盟（例如，工作联盟的沟通技巧培训；Meystre 等人，2012）。其次，医务人员（例如精神病学住院医师）的培训课程将包括建立治疗联盟的指导。第三，确定这些机制可以帮助创建一种具体的患者护理方法，其中仅针对可能需要的患者采用提高药物依从性的特定干预措施。因此，拟议的研究对未来的研究和医务人员的培训具有广泛的影响。