Collaborative Care for Depressed Elders in China

中国抑郁老人的协作护理

基本信息

批准号：
7946353
负责人：
Shulin Chen
金额：
$ 5.4万
依托单位：
ZHEJIANG UNIVERSITY
依托单位国家：
美国
项目类别：
财政年份：
2010
资助国家：
美国
起止时间：
2010-08-01 至 2014-07-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7946353
关键词：
Address Adherence Adverse effects Antidepressive Agents Appointment Attitude Care given by nurses Caring Case Manager China Chinese People Chronic Disease Client satisfaction Clinic Clinical Clinical Research Communication Consultations Country Data Depressed mood Diabetes Mellitus Diagnosis Disease Management Effectiveness Elderly Equation Evaluation Family Future Goals Guidelines Health Care Costs Health Knowledge, Attitudes, Practice Health Policy Hypertension Intervention Knowledge Link Major Depressive Disorder Mental Depression Mental Health Modeling Monitor National Health Policy Outcome Patient Care Patients Pharmaceutical Preparations Practice Management Primary Care Physician Primary Health Care Primary Nursing Care Protocols documentation Provider Psychiatrist Public Health Quality Indicator Quality of life Questionnaires Randomized Randomized Controlled Trials Relative (related person)Research Route SF-12 Severities Stigmata Suicide Supervision Testing Time United States Weight arm base clinical remission collaborative care compliance behavior depressive symptoms design effective therapy follow-up functional disability geriatric depression health care delivery improved medical specialties older patient primary care setting public health priorities public health relevance satisfaction social stigma suicidal risk theories trial comparing uptake

项目摘要

DESCRIPTION (provided by applicant): As a major public health issue in China and worldwide, late life depression is associated with physical limitations, greater functional impairment, increased utilization and cost of health care, and suicide. Like other chronic diseases in elders such as hypertension and diabetes, depression is a chronic disease that the new National Health Policy of China (2009 released) indicates should be managed in primary care settings. Collaborative care, linking primary and mental health specialty care, has been shown to be effective for the treatment of late life depression in primary care settings in Western countries. Based on chronic disease management theory and the collaborative care model (CCM), we propose to test a Depression Care Management (DCM) intervention, which includes treatment guidelines (TG) to support primary care physicians' (PCPs) management of depression in their older patients; primary care nurses as care managers (CMs) to monitor the progress of treatment, support patient's adherence, educate patients/family and facilitate communication between providers; and psychiatrists to provide consultation and supervision of care managers. Using a randomized controlled design, we will examine whether the DCM is an effective treatment for patients with late life depression in urban China. Our specific aims are: (1) to determine whether the DCM intervention results in improved outcomes compared with CAU at both the provider (e.g., greater adherence to quality indicators) and patient levels (e.g., greater reduction in depressive symptoms); and (2) to compare DCM with CAU with regard to a range of outcomes in other pertinent domains, both at the provider (e.g., improvements in knowledge/attitudes) and patient (e.g., functioning, satisfaction) levels. The study will take place in 16 primary care clinics (PCCs) randomly assigned to deliver either DCM or CAU (8 clinics each) to 320 patients (agede60 years) with major depression (20/clinic; n=160 in each treatment condition). In the DCM arm, PCPs will prescribe 16 weeks of antidepressant medication according to the TG protocol. CMs monitor the progress of treatment and side effects, educate patients/family, and facilitate communication between providers; psychiatrists will provide weekly group psychiatric consultation and CM supervision. Patients in both DCM and CAU arms will be assessed by clinical research coordinators at baseline, 4, 8, 12, 18, and 24 months. HDRS, MMSE, CAS, SF-12, Treatment Stigma and the Client Satisfaction Questionnaire will be used to assess patients' outcomes; and clinic practices, attitudes/knowledge, and satisfaction will be providers' outcomes. The weighted generalized estimating equations (WGEE) and generalized linear mixed-effects model (GLMM) will be used to analyze the longitudinal data. This proposed project would increase our understanding of the effectiveness of the CCM for late life depression in Chinese primary care settings, and lay the groundwork for future R01 proposals. PUBLIC HEALTH RELEVANCE: Depression in late life is a global public health problem, and particularly under-detected and undertreated in China, with research suggesting that over 90% of patients in China have not been diagnosed or treated. The National Health Care Policy of China has designated depression as a public health priority and proposes that depression be managed in primary care settings. The proposed study tests the effectiveness of depression care management in Chinese primary care settings as one route to addressing the public health burden of late life depression.

描述（由申请人提供）：作为中国和全球的一个主要公共卫生问题，晚期抑郁症与身体局限性，功能障碍更大，利用率增加和医疗保健成本以及自杀有关。像高血压和糖尿病等长老中的其他慢性疾病一样，抑郁症是一种慢性疾病，中国新的国家卫生政策（2009年发布）表示应在初级保健环境中进行管理。连接初级和心理健康专业护理的协作护理已被证明可有效治疗西方国家初级保健环境中的晚期抑郁症。根据慢性疾病管理理论和协作护理模型（CCM），我们建议测试抑郁症护理管理（DCM）干预措施，其中包括治疗指南（TG），以支持老年患者的抑郁症的初级保健医生（PCP）；作为护理经理（CMS）的初级保健护士，以监测治疗的进展，支持患者的依从性，教育患者/家庭并促进提供者之间的沟通；和精神科医生提供护理经理的咨询和监督。使用随机控制的设计，我们将检查DCM是否是中国城市抑郁症患者的有效治疗方法。我们的具体目的是：（1）确定DCM干预措施是否在提供者（例如，对质量指标更大的依从性）和患者水平（例如，抑郁症状的降低更大）是否会导致结果改善；（2）将DCM与CAU进行有关其他相关领域的一系列结果（例如，知识/态度的改善）和患者（例如功能，满意度）水平进行比较。该研究将在随机分配的16个初级保健诊所（PCC）中进行，以将DCM或CAU（每个诊所）送到320名患者（60岁），患有严重抑郁症（20/诊所； n = 160个治疗条件下）。在DCM部门中，PCP将根据TG方案开出16周的抗抑郁药。 CMS监测治疗和副作用的进展，教育患者/家庭，并促进提供者之间的沟通；精神科医生将提供每周的小组精神病学咨询和CM监督。 DCM和CAU臂的患者将由基线4、8、12、18和24个月的临床研究协调员进行评估。 HDRS，MMSE，CAS，SF-12，治疗污名和客户满意度问卷将用于评估患者的结果；提供者的成果和诊所实践，态度/知识和满意度将是提供者的成果。加权广义估计方程（WGEE）和广义线性混合效应模型（GLMM）将用于分析纵向数据。该提议的项目将提高我们对中国初级保健环境中CCM对晚期抑郁症的有效性的理解，并为未来的R01提案奠定了基础。公共卫生相关性：晚期抑郁症是一个全球公共卫生问题，尤其是在中国检测到的不足和治疗不足，研究表明，中国超过90％的患者尚未被诊断或治疗。中国国家卫生保健政策将抑郁症指定为公共卫生的重点，并提出在初级保健环境中进行抑郁症。拟议的研究测试了中国初级保健环境中抑郁症护理管理的有效性，这是解决晚期抑郁症的公共卫生负担的一种途径。