Telemonitoring Enhanced Support for Depression Self Management

远程监控增强对抑郁症自我管理的支持

• 批准号: 8683239
• 负责人: James E Aikens
• 金额: $ 59.47万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2012
• 资助国家: 美国
• 起止时间: 2012-09-18 至 2017-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8683239
• 关键词: Abbreviations; Acute; Address; Adult; Antidepressant adherence; Area; Behavioral; Caregivers; Caring; Case Manager; Cells; Child; Chronic; Clinic; Clinical; Community Health; Community Practice; Computers; Depressed mood; Disease remission; Economically Deprived Population; Effectiveness; Electronic Mail; Event; Exhibits; Eye; Family member; Federally Qualified Health Center; Feedback; Friends; Health; Health Benefit; Health Care Costs; Helping Behavior; Home environment; Household; Impairment; Internet; Intervention; Interview; Life; Link; Low income; Mental Depression; Mental disorders; Methods; Monitor; Moods; Outcome; Participant; Patient Monitoring; Patients; Personal Satisfaction; Persons; Primary Health Care; Public Health; Reporting; Research; Research Infrastructure; Risk; Rural Health Centers; Self Care; Self Management; Services; Severities; Social Network; Social isolation; Specific qualifier value; Spouses; System; Technology; Telefacsimile; Telephone; Testing; Time; Training; Treatment Efficacy; Underinsured; Update; Visit; Voice; Work; base; burnout; care giving burden; compare effectiveness; cost; depressive symptoms; design; follow-up; functional disability; improved; innovation; medically underserved; medically underserved population; member; primary outcome; public health relevance; response; satisfaction; secondary outcome; social; therapy development; tool; treatment as usual; uptake

DESCRIPTION (provided by applicant): Although depression care management improves outcomes, its widespread uptake is hindered by limitations in infrastructure, reimbursement, and interventionist time. As a result, care managers are often unable to provide the time intensive support that many depressed patients need in order to achieve optimal outcomes. While this service gap can be partly offset by support from an in-home caregiver (ICG), ICGs lack formal tools to effectively monitor patients' clinical needs and support their self-management. ICGs are also at risk for caregiver burnout due to competing demands and social isolation. Finally, many patients have no ICG. We propose to address these problems with a practical intervention that uses low cost technologies to activate depressed patients' existing social networks for self-management support, without requiring patients to use a computer. The intervention links patients with a "CarePartner" (CP), i.e., a non-household family member or close friend who is willing to support the patient in coordination with the clinician and any existing ICG. Through weekly automated telemonitoring, patients report their mood and self-management status, and receive tailored guidance on self-management. The CP receives a corresponding update along with guidance on how to best support the patient's self-management efforts, and the primary care team is notified about clinically urgent situations. Our pilot work demonstrates the intervention's feasibility and potential effectiveness, such that patients consistently engaged in telemonitoring, CP and clinician reports were successfully issued, and depressive symptoms reduced significantly. We now plan to rigorously evaluate the intervention's efficacy among depressed primary care patients from clinics serving low-income and underinsured patients, whom the intervention was especially designed to benefit. Specific Aim 1 is to conduct an RCT to compare the effectiveness of one year of telemonitoring-supported CP for depression versus usual care (control) on depression severity. Specific Aim 2 is to examine key secondary outcomes (response and remission, impairment, well-being, caregiving burden, healthcare costs) and potential moderators. Specific Aim 3 is to use a mixed-methods approach to enrich our interpretation of the statistical associations, and to discover strategies to enhance the intervention's acceptability, effectiveness, and sustainability. If the intervention proves effectie without increasing clinician burden or marginal costs, then its subsequent implementation could yield major public health benefits, especially in medically underserved populations. Societal benefit may also occur through the promotion of helping behavior and social ties. Follow-up research could implement the intervention, and extend its focus to specific depression subtypes as well as other chronic psychiatric disorders. In this resubmitted proposal, we respond to Reviewers' feedback by adding specialized experts to our team, strengthening our participant protections, and providing additional methodological details. PUBLIC HEALTH RELEVANCE: We have developed a telephone-based system called CarePartners to improve depression outcomes by training a family member or close friend to support the depressed person, even from long distance. Our proposed project will determine whether CarePartners is more effective than usual care at improving patients' depression symptoms and other key outcomes. If this simple and inexpensive approach is effective, then this research could result in extraordinary public health benefits, particularly for vulnerable patient groups such as the medically underserved.

描述（由申请人提供）：尽管抑郁症护理管理改善了结果，但其广泛的吸收受到基础设施，报销和干预主义时间的局限性的阻碍。结果，护理经理通常无法提供许多抑郁症患者所需的时间密集型支持，以实现最佳结果。虽然该服务差距可以被内部护理人员（ICG）的支持部分抵消，但ICG缺乏正式的工具来有效监测患者的临床需求并支持他们的自我管理。由于需求和社会隔离，ICG也有照顾者倦怠的风险。最后，许多患者没有ICG。 我们建议通过实用干预措施解决这些问题，该干预措施使用低成本技术激活抑郁症患者的现有社交网络以进行自我管理支持，而无需患者使用计算机。干预措施将患者与“ Carepartner”（CP）的患者联系起来，即愿意与临床医生和任何现有ICG协调的非家庭家庭成员或密友。通过每周自动远程监控，患者报告了自己的情绪和自我管理状况，并获得有关自我管理的量身定制指导。 CP将收到相应的更新以及有关如何最好地支持患者的自我管理工作的指导，并通知初级保健团队有关临床紧急情况的通知。我们的飞行员工作证明了干预的可行性和潜在有效性，以便成功发出了远程监控，CP和临床医生报告的患者，并且抑郁症状大大降低。 现在，我们计划严格评估干预措施的抑郁初级保健患者的疗效，该诊所为低收入和保险不足的患者提供干预措施，这些干预措施旨在受益。具体目的1是进行RCT，以比较远程监控支持CP的抑郁症与抑郁严重程度的常见护理（对照）的有效性。具体目标2是检查关键的次要结果（反应和缓解，障碍，福祉，护理负担，医疗保健费用）和潜在的主持人。特定目的3是使用混合方法来丰富我们对统计关联的解释，并发现增强干预措施的可接受性，有效性和可持续性的策略。如果干预措施在不增加临床医生负担或边际成本的情况下证明了影响，那么其随后的实施可能会带来重大的公共卫生福利，尤其是在医疗服务不足的人群中。社会利益也可能通过促进行为和社会联系而发生。后续研究可以实施干预措施，并将其重点扩展到特定的抑郁症亚型以及其他慢性精神病。 在此重新提交的建议中，我们通过向我们的团队添加专业专家，加强我们的参与者保护并提供其他方法论细节来回应审阅者的反馈。 公共卫生相关性：我们已经开发了一种名为Carepartner的电话系统，可以通过训练家庭成员或亲密朋友来支持沮丧的人，即使是从长远来看。我们拟议的项目将确定卡雷佩纳人是否比通常的护理更有效，可以改善患者的抑郁症状和其他关键结果。如果这种简单且廉价的方法有效，那么这项研究可能会带来极大的公共卫生益处，特别是对于诸如医疗服务不足之类的脆弱患者群体。