Motivational Interviews Adapted to Improve Depression Treatment in Primary Care

励志访谈旨在改善初级保健中的抑郁症治疗

• 批准号: 7588194
• 负责人: ROBERT Denius KEELEY
• 金额: $ 17.25万
• 依托单位: DENVER HEALTH AND HOSPITAL AUTHORITY
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-03-10 至 2014-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7588194
• 关键词: Acute; Adherence; Antidepressant adherence; Antidepressive Agents; Caring; Chronic; Classification; Clinical; Consultations; Counseling; Data; Development; Disease remission; Effectiveness; Evidence based treatment; Foundations; Guidelines; Individual; Intervention; Interview; Literature; Major Depressive Disorder; Measures; Mediating; Mediator of activation protein; Medical; Mental disorders; Mentored Patient-Oriented Research Career Development Award; Mentors; Methods; Mood Disorders; National Institute of Mental Health; Outcome; Patients; Pharmacotherapy; Phase; Physicians; Primary Care Physician; Primary Health Care; Procedures; Randomized Clinical Trials; Randomized Controlled Trials; Recovery; Relative (related person); Reporting; Research; Research Activity; Research Proposals; Risk; Sampling; Self Efficacy; Site Visit; Structure; Testing; Therapeutic; Time; Training; Underrepresented Minority; base; depression; depressive symptoms; design; disability; improved; motivational enhancement therapy; multidisciplinary; novel; primary care setting; programs; psychosocial; secondary outcome; skills; therapeutic target; treatment adherence

DESCRIPTION (provided by applicant): The Mentored Patient-Oriented Research Career Development Award (K23) will support the candidate in building the foundation for a programmatic line of research developing and testing brief psychosocial treatments to improve treatment adherence and clinical outcome for primary care patients with mood disorders, and integrating them across the spectrum of primary care settings. Major depression is prevalent, a leading cause of disability, and not optimally treated in primary care. Poor adherence to evidence-based treatment for depression is a pervasive impediment to satisfactory clinical outcomes, yet few psychosocial treatments have been specifically developed and tested to improve adherence. The proposal includes intensive multidisciplinary mentoring toward developing skills in measuring adherence and identifying baseline and mediating determinants of adherence and clinical course, and designing and implementing randomized clinical trials and conducting research with underserved and minority individuals. Detailed formal coursework, site visits, and targeted consultations will complete the educational plan. The proposed project aims to refine and test an empirically-based, structured psychosocial intervention provided by the treating physician to improve adherence to pharmacotherapy, Adapted Motivational Interviewing (AMI). The project will include two phases. In phase 1, AMI will be piloted with 16 patients to assess feasibility and acceptability from patient and physician perspectives and for treatment fidelity. These findings will be used to refine the treatment, assessment, and physician training procedures and to finalize the brief AMI sessions. In Phase 2, a small randomized controlled trial with 160 patients will be conducted to: 1) compare AMI combined with Guideline-Based Medical Management for Depression (GBMM) to GBMM alone in improving adherence to antidepressant therapy and in improving depressive symptoms for patients beginning a new treatment episode for depression; and 2) generate effect sizes for a trial to detect unproved depression remission. The educational and research activities will provide the candidate with the skills and expertise needed to launch a systematic program of research aimed at developing and implementing effective psychosocial treatments for primary care patients with mood disorders at risk for poor adherence to depression treatment. The treatments will contribute to reducing the suffering associated with poor antidepressant adherence.

描述（由申请人提供）：受过指导的面向患者的研究职业发展奖（K23）将支持候选人为计划开发和测试简短的心理社会心理治疗方案建立基础，以改善对初级保健患者的治疗依从性和情绪障碍患者的临床结果，并将其整合在主护理环境中。严重抑郁症普遍存在，是残疾的主要原因，并且在初级保健中没有最佳治疗。对抑郁症的基于证据的治疗的依从性不佳是令人满意的临床结果的普遍障碍，但很少有专门开发和测试的社会心理治疗以提高依从性。该提案包括密集的多学科指导，以培养技能，以衡量依从性，识别基线和介导依从性和临床课程的决定因素，以及设计和实施随机的临床试验并与服务不足和少数人进行研究。详细的 正式的课程工作，现场访问和有针对性的咨询将完成教育计划。拟议的项目旨在完善和测试由治疗医师提供的基于经验的，结构化的社会心理干预措施，以提高对药物疗法的依从性，适应性的动机访谈（AMI）。该项目将包括两个阶段。在第1阶段，AMI将被16名患者试用，以评估患者和医师的观点以及治疗保真度的可行性和可接受性。这些发现将用于完善治疗，评估和医师培训程序并完成简短的AMI课程。在第2阶段中，将进行一项小型随机对照试验，进行160例患者进行：1）将AMI与基于指南的抑郁症医疗管理（GBMM）与GBMM相比，以改善对抗抑郁药治疗的依从性，并改善抑郁症状的患者的抑郁症状。 2）生成试验的效应大小，以检测未证实的抑郁缓解。教育和研究活动将为候选人提供启动系统的研究计划所需的技能和专业知识，旨在为具有不良依从性抑郁症治疗的情绪障碍患者的初级保健患者开发和实施有效的社会心理治疗。这些治疗方法将有助于减少与抗抑郁药依从性差有关的苦难。