Outreach to Reduce Disparities in Depression Treatment Initiation

开展外展活动，减少抑郁症治疗启动方面的差异

• 批准号: 10021737
• 负责人: Beth E. Waitzfelder
• 金额: --
• 依托单位: KAISER FOUNDATION RESEARCH INSTITUTE
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-09-23 至 2024-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10021737
• 关键词: Address; Adherence; African American; Aftercare; Antidepressive Agents; Asians; Caring; Clinical; Data; Diagnosis; Disease remission; Drops; Education; Ethnic group; Failure; Health system; Healthcare Systems; Hispanics; Income; Intervention; Intervention Studies; Mental Depression; Mental Health; Native Hawaiian; Not Hispanic or Latino; Outcome; Pacific Island Americans; Patient Care; Patients; Pharmaceutical Preparations; Pilot Projects; Population; Primary Health Care; Provider; Psychotherapy; Race; Randomized; Records; Research; Research Personnel; Technology; Testing; Time; Visit; Work; alternative treatment; arm; care outcomes; care providers; collaborative care; comparison intervention; design; disparity reduction; eHealth; effectiveness testing; ethnic minority population; experience; follow-up; group intervention; improved; improved outcome; outreach; outreach program; pilot trial; pragmatic trial; preference; primary outcome; programs; racial and ethnic disparities; racial minority; response; secondary outcome; telehealth; therapy design; treatment adherence; treatment as usual; usual care arm

Failure to initiate treatment is a major gap in care for depression - A recent Mental Health Research Network (MHRN) study involving more than 240,000 patients in 5 health systems with a new diagnosis of depression in primary care found that only about a third (36%) had completed a psychotherapy visit or filled a prescription for antidepressant medication within 90 days of a new depression diagnosis. Large racial and ethnic disparities in depression treatment initiation exist – In that MHRN study the odds of Asians, Blacks and Hispanics initiating treatment were 30% lower than for Non-Hispanic Whites. Previous research has focused on care after treatment initiation – Collaborative care and care management programs can reduce disparities, improving outcomes among traditionally under-served racial and ethnic groups. This work, however, has usually focused on those who have already initiated treatment. Interventions improve treatment initiation must accommodate diversity of patient experience and preferences –Underserved racial and ethnic groups may prefer psychotherapy over medication and may also prefer alternative treatments or alternative care providers. One size of depression treatment does not fit all. eHealth technologies have the potential to address failures in treatment initiation – Previous research by MHRN investigators and others demonstrates that online messaging and other telehealth technologies can effectively and efficiently improve depression treatment adherence. These interventions, however, have focused on adherence after treatment initiation and have been tested primarily in non-Hispanic white patients. Proposed trial: This pilot study will refine, adapt and test an outreach intervention to improve depression treatment initiation among patients recently receiving a new diagnosis of depression in primary care. Focusing on African American, Asian, Native Hawaiian/Pacific Islander and Hispanic patients, the study will leverage existing MHRN work to implement an automated outreach program with follow-up care facilitation by mental health clinicians. The intervention will utilize analytic and technological expertise developed by the MHRN to rapidly identify patients, send outreach messages, conduct assessments and facilitate care for patients with depression who fail to initiate treatment in a timely manner. The intervention will be developed with the input of patients in the target racial and ethnic minority populations and providers. Approximately 400 eligible patients in two MHRN health systems will be randomized to the intervention group or usual care. Outcomes (treatment initiation and rates recorded depression remission and response) will be ascertained from health system records. Analyses will examine intervention participation and compare the primary outcome (treatment initiation) and secondary outcomes (recorded depression remission and response) between groups. Results will inform a subsequent full-scale pragmatic trial to assess reduction in population-level disparities.

未能开始治疗是抑郁症护理的一个主要差距——最近的一项心理健康研究 网络 (MHRN) 研究涉及 5 个卫生系统的 240,000 多名患者，新诊断为 初级保健中的抑郁症发现，只有约三分之一 (36%) 完成了心理治疗访问或填写了 新诊断抑郁症后 90 天内开出抗抑郁药物处方。 在开始抑郁症治疗方面存在巨大的种族和民族差异——在那项 MHRN 研究中，可能性 亚洲人、黑人和西班牙裔开始接受治疗的比例比非西班牙裔白人低 30%。 先前的研究重点是治疗开始后的护理——协作护理和护理 管理计划可以减少差距，改善传统上服务不足的种族之间的结果 然而，这项工作通常侧重于那些已经开始治疗的人。 改善治疗开始的干预措施必须适应患者经历的多样性和 偏好——服务不足的种族和族裔群体可能更喜欢治疗而不是药物治疗，也可能 偏爱替代疗法或替代护理提供者 一种抑郁症治疗方法并不适合所有人。 电子医疗技术有可能解决治疗启动失败的问题——先前的研究 MHRN 调查人员和其他人证明，在线消息传递和其他远程医疗技术可以 然而，这些干预措施有效地提高了抑郁症治疗的依从性。 重点关注治疗开始后的依从性，并主要在非西班牙裔白人患者中进行了测试。 拟议的试验：这项试点研究将完善、调整和测试外展干预措施，以改善抑郁症 最近在初级保健中新诊断出抑郁症的患者开始治疗。 该研究将针对非裔美国人、亚洲人、夏威夷原住民/太平洋岛民和西班牙裔患者 现有的 MHRN 工作是实施自动化外展计划，并由精神科人员提供后续护理协助 该干预措施将利用 MHRN 开发的分析和技术专业知识来 快速识别患者、发送外展信息、进行评估并促进对患者的护理 未能及时开始治疗的抑郁症患者，将根据以下人员的意见制定干预措施。 约 400 名符合条件的患者 在两个 MHRN 卫生系统中，将被随机分配到干预组或常规护理组。 抑郁症缓解和缓解的起始率和记录率）将由卫生系统确定 分析将检查干预参与并比较主要结果（治疗）。 组间的次要结果（记录的抑郁症缓解和反应）。 将为随后的全面实用试验提供信息，以评估人口水平差距的缩小情况。