Population-Based Psychiatric Intervention in Primary Care

初级保健中基于人群的精神科干预

• 批准号: 7658381
• 负责人: WAYNE J KATON
• 金额: $ 15.27万
• 依托单位: UNIVERSITY OF WASHINGTON
• 依托单位国家: 美国
• 财政年份: 2004
• 资助国家: 美国
• 起止时间: 2004-02-17 至 2012-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7658381
• 关键词: Adherence; Adolescent; Adverse effects; Anxiety; Anxiety Disorders; Attention deficit hyperactivity disorder; Award; Behavioral; Biometry; Blood Pressure; Caring; Chronic; Chronic Disease; Clinical; Coronary heart disease; Depressive disorder; Diabetes Mellitus; Discipline of obstetrics; Disease; Effectiveness; Epidemiologic Studies; Epidemiology; Fasting; Glucose; Goals; Grant; Guidelines; Gynecology; Health Services Research; Healthcare; Intervention; Knowledge; Life; Longitudinal Studies; Major Depressive Disorder; Medical; Mental Health; Mental Health Services; Mentors; Mentorship; Midcareer Investigator Award in Patient-Oriented Research; Modeling; National Institute of Mental Health; Outcome; Patients; Pattern; Population; Primary Health Care; Quality of Care; Reading; Research; Research Activity; Research Personnel; Research Support; Residual state; Risk Factors; Rural; Screening procedure; Subgroup; Symptoms; Telemedicine; Testing; Treatment Protocols; Treatment outcome; Woman; Youth; base; care systems; chronic depression; collaborative care; cost; depression; depressive symptoms; disorder control; experience; functional disability; health economics; high risk; improved; innovation; medical complication; meetings; mortality; population based; primary care setting; professor; programs; skills

DESCRIPTION (provided by applicant): This is a request for a competing renewal of an NIMH Midcareer Investigator Award in Patient-Oriented Research (NIMH staff has advised Dr. Katon that he could submit a competing renewal of his K-24 award as a full professor). This K-24 will build on Dr. Katon's prior research in: 1) developing innovative "collaborative care" interventions to improve the quality of care and outcomes of patients with depressive and anxiety disorders within primary care settings; 2) improving understanding about the adverse impact of anxiety and depressive disorders in patients with common medical disorders; and 3) developing interventions to improve psychiatric outcomes in patients with chronic medical illness and comorbid depressive and anxiety disorders. The specific aims of this proposal include: 1) to continue to enhance Dr. Katon's epidemiologic, biostatistical and health economic skills in order to demonstrate in population-based studies the bidirectional adverse interactions between depression and chronic medical illness. The evidence from these population- based studies will be developed by a) showing in cross-sectional and longitudinal studies the adverse impact of depression on medical symptom burden, functional impairment, adherence to medical regimens, medical complications and mortality; and b) by demonstrating in longitudinal studies that residual depressive symptoms and incident complications of medical illness are associated with a higher risk of developing major depression and new deficits in functioning. Additional aims include: 2) to develop and test adaptations of collaborative care models in patients with depression and chronic medical illness that are targeted at improving medical disease control, behavioral risk factors, as well as improving quality of depression care; 3) to continue to adapt collaborative care interventions and test their effectiveness in new populations experiencing disparities in quality of mental health care such as adolescent populations with depression, youth with attention-deficit hyperactivity disorder (ADHD) living in rural settings, and women with depression treated in Ob-Gyn settings; and 4) To continue to expand Dr. Katon's mentorship of junior investigators in mental health services research. These goals will be met through continued and expanded research activities, coursework in epidemiology, biostatistics and health economics and mentorship from external consultants. These courses, interactions with mentors, and mentored readings will improve Dr. Katon's ability as a mentor as well as enhancing the cutting edge research of his Health Services Division. RELEVANCE: The research that will be completed during the course of this award will increase knowledge about the importance of screening for and treating depression in patients with chronic medical illnesses; test new models of care in patients with depression and chronic medical illnesses aimed at improving quality of quality of depression and medical care; and adapt the collaborative care model to new populations (youth with ADHD and depression and women treated in Ob-Gyn settings) that experience disparities in quality of mental health care.

描述（由申请人提供）：这是对以患者为导向的研究领域的 NIMH 职业生涯中期研究者奖竞争性更新的请求（NIMH 工作人员建议 Katon 博士，他可以提交其 K-24 奖项的竞争性更新作为完整的奖励）教授）。该 K-24 将建立在 Katon 博士之前的研究基础上：1）开发创新的“协作护理”干预措施，以提高初级护理机构中抑郁症和焦虑症患者的护理质量和结果； 2) 提高对常见内科疾病患者焦虑和抑郁障碍不良影响的认识； 3) 制定干预措施，改善患有慢性疾病和共病抑郁症和焦虑症的患者的精神结局。该提案的具体目标包括：1）继续提高卡顿博士的流行病学、生物统计学和卫生经济学技能，以便在基于人群的研究中证明抑郁症和慢性疾病之间的双向不利相互作用。这些基于人群的研究的证据将通过以下方式得到：a) 在横断面和纵向研究中显示抑郁症对医疗症状负担、功能障碍、医疗方案依从性、医疗并发症和死亡率的不利影响； b) 通过纵向研究证明，残留的抑郁症状和医疗疾病的并发症与患重度抑郁和新的功能缺陷的较高风险相关。其他目标包括：2）开发和测试针对抑郁症和慢性疾病患者的协作护理模式的适应性，旨在改善医疗疾病控制、行为风险因素以及提高抑郁症护理质量； 3) 继续调整协作护理干预措施，并测试其在精神卫生保健质量差异的新人群中的有效性，例如患有抑郁症的青少年群体、生活在农村地区的患有注意力缺陷多动障碍（ADHD）的青少年以及患有抑郁症的妇女在妇产科环境中接受治疗； 4) 继续扩大 Katon 博士对心理健康服务研究中初级研究者的指导。这些目标将通过持续和扩大的研究活动、流行病学、生物统计学和卫生经济学课程以及外部顾问的指导来实现。这些课程、与导师的互动以及指导阅读将提高卡顿博士作为导师的能力，并加强其健康服务部门的前沿研究。相关性：将在该奖项期间完成的研究将增加人们对慢性疾病患者筛查和治疗抑郁症重要性的认识；测试抑郁症和慢性疾病患者的新护理模式，旨在提高抑郁症和医疗护理的质量；并使协作护理模式适应在心理健康护理质量方面存在差异的新人群（患有多动症和抑郁症的青少年以及在妇产科接受治疗的女性）。