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：
8235150
负责人：
BRUCE Lawrence ROLLMAN
金额：
$ 71.35万
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/8235150
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. PUBLIC HEALTH RELEVANCE: Depression and anxiety are common in primary care practice and are associated with substantial reductions in health-related quality of life. This Project will test the comparative effectiveness of two on-line treatments for these conditions provided through the context of a Collaborative Care program: (1) moderated access to a proven-effective computerized cognitive behavioral therapy (CCBT) program; versus (2) moderated access to CCBT plus an Internet support group (CCBT+ISG). The Project will also compare the effectiveness of these treatments to PCPs' "usual care" for these conditions, and evaluate the adoption and maintenance of CCBT+ISG by practices following the conclusion of the trial to provide a greater understanding of how to best scale the delivery of these interventions into a variety of primary care settings.

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）大幅下降有关，并导致发病率显着过高。作为回应，数十项试验表明，与初级保健医生的常规护理相比，“协作护理”对这些疾病的效果更佳。但由于多种原因，这些模型尚未得到广泛实施。因此，迫切需要开发和测试更具可扩展性、更强大和创新的协作护理版本，同时更深入地了解如何通过初级护理（大多数抑郁和焦虑患者寻求治疗）最好地提供这些干预措施。数以千计的网站提供医疗信息，并且公众可以在其中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，临床试验尚未证实以这种方式利用互联网的好处。与此同时，一些计算机化认知行为疗法 (CCBT) 项目已被证明可以有效治疗情绪和焦虑障碍患者，并已被美国以外的数十万患者使用。然而，CCBT 在美国国内的使用率仍然很低，而且还没有任何试验证明 CCBT 能够有效治疗情绪障碍和焦虑症患者。将 CCBT 纳入协作护理干预措施或检查 CCBT 与 ISG 结合治疗这些疾病的有效性。我们建议进行一项为期 4 年的比较有效性试验，将随机抽取 700 名 18-75 岁的初级保健患者，这些患者至少有中等程度的情绪和/或焦虑症状，并且可以可靠地访问互联网和发送电子邮件至：（1 ) 指导患者访问 Beating the Blues，这是一个经过验证有效的在线 CCBT 计划（单独 CCBT；N=300）； (2) 指导患者参加 Beating the Blues 课程以及适度的 ISG（CCBT+ISG；N=300）； (3) 他们的 PCP 的“常规护理”(N=100)。我们的主要假设是，在 6 个月的随访中，与单独 CCBT 组的患者相比，CCBT+ISG 组的患者在 SF-12 MCS 上的 HRQoL 会报告有临床意义的 0.30 效应值 (ES) 或更大的改善，我们将额外监测患者 6 个月，以评估我们干预措施的持久性。我们的次要假设是，与“常规护理”相比，单独使用 CCBT 的患者在 6 个月的随访中将报告 SF-12 MCS 的 HRQoL 提高 0.50 ES 或更大。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，我们还将评估：(a) 它们在各个年龄段和各个年龄段内的有效性； (b) 其成本效益； (c) 患者如何利用我们的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) 通过项目干预阶段之后的实践来采用和维持我们的干预措施。研究结果可能会对改变初级保健中治疗心理健康状况的方式产生深远影响，并进一步引起美国其他研究人员对电子心理健康这一新兴领域的关注。公共卫生相关性：抑郁和焦虑在初级保健实践中很常见，并且与健康相关的生活质量大幅下降有关。该项目将测试通过协作护理计划提供的两种在线治疗方法对这些病症的比较有效性：(1) 适度访问经证明有效的计算机认知行为治疗 (CCBT) 计划；对比 (2) CCBT 的适度访问加上互联网支持小组 (CCBT+ISG)。该项目还将比较这些治疗方法与 PCP 对这些病症的“常规护理”的有效性，并通过试验结束后的实践评估 CCBT+ISG 的采用和维持，以更好地了解如何最好地扩大治疗范围将这些干预措施提供给各种初级保健机构。