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：
8440832
负责人：
JURGEN UNUTZER
金额：
$ 29.96万
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 2016-03-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/8440832
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 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 screening 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.]

描述（由申请人提供）：背景：主要的抑郁发作发生在整个女性的寿命中，在生殖和绝经期间的比率最高。在此期间，ob-gyns是许多妇女经常看到的唯一提供者。低收入和少数民族妇女特别有可能在OB-GYN诊所寻求常规护理。 OB-GYN诊所的诊断和抑郁症护理质量的准确性存在明显的差距，抑郁症护理质量的差异超过了初级保健诊所中看到的差异。将抑郁症护理纳入临床环境的模型可能适用于OB-GYN环境，但尚未在围产期之外进行测试。大多数妇女被ob-gyn所见。因此，仅关注围产期抑郁症的研究不包括大量可以从护理中受益的妇女。迄今为止，还没有完成研究将抑郁症护理模型适应整个诊所。研究目标：我们提出了一项由（i）增强教育组成的分为三部分的干预措施，并与OB-GYN护理融为一体；（ii）参与；（iii）抑郁症护理管理（抗抑郁药监测和/或简短心理治疗的提供）。我们假设将三部分的抑郁干预措施集成到OB-GYN临床环境中，将改善抑郁症，功能结果和对抑郁症护理满意度的治疗结果。研究设计：在拟议的随机对照试验中，将分配260例重度抑郁症和/或心律失常的OB-GYN诊所患者：1）综合抑郁干预措施或2）常规护理（UC）。我们将筛选约8300名在18个月以上的城市OB-GYN诊所的预定诊所任命的患者，以期为重度抑郁症/心情障碍。这些患者中有很大一部分是低收入和少数族裔妇女。诊所提供者也可能会转介有符合条件的患者，或者对诊所中发布的信息传单的答复。综合抑郁干预将持续12个月。盲人研究人员的电话采访将在基线和6、12和18个月的时间进行评估。目的：我们的主要目的是：1）与UC相比，评估OB-GYN抑郁症干预对抑郁症治疗结果的影响，包括抑郁症状的变化和抑郁症治疗反应； 2）与UC相比，评估综合OB-GYN抑郁干预对功能结果的影响。我们的次要目的是：3）与UC相比，综合OB-GYN抑郁干预对抑郁症护理指标质量的影响，包括治疗次数，剂量，持续时间和依从性抗抑郁药；并满足于抑郁症护理，包括患者和提供者满意度，以及提供者对OB-GYN诊所中抑郁症护理的态度； 4）[确定综合OB-GYN干预措施可持续性的潜在促进者和障碍。]