This services R34 research study will provide important effectiveness pilot data to assess an intervention that includes a focus on adherence because poor adherence to depression treatment remains a significant impediment to improving care, in particular in the context of co morbid physical conditions such as hypertension. Training Licensed Practical Nurses (LPNs) who are already working in the practices to carry out the intervention will facilitate its deployment in real world practices with limited resources and competing demands. The primary aims of this proposal to be carried out in the primary care setting are: (1) Design an integrated intervention strategy to be carried out by LPNs who are already working in the practices to improve adherence to antidepressant treatment in the context of improving adherence to antihypertensive treatment for older primary care patients through integration of management of both depression and hypertension;(2) Test the feasibility and assess in a preliminary fashion the effectiveness of the integrated intervention strategy carried out by LPNs who are already working in the practices on the primary outcome of adherence to adequate antidepressant treatment by enrolling 100 adults aged 65 years and older with clinically significant depression and a systolic blood pressure (BP) >140 mmHg or diastolic blood pressure (BP) >90 mmHg for non-diabetics, or a systolic BP >130 or a diastolic BP >80 for diabetic patients. Exploratory outcomes that will be the primary outcomes of the future R01 will be depression response and remission, adherence to adequate antihypertensive treatment, and improved blood pressure control;and (3) Use data from this developmental study to develop an R01 for a full-scale randomized controlled trial of the intervention carried out by LPNs who are already working in the practices that integrates depression and hypertension management. The key components of the Integrated Care Intervention are: (1) integration of depression treatment with hypertension management;and (2) provision of an individualized program to improve adherence to antidepressant and antihypertensive medications that recognizes patients'social and cultural context. This project can have a significant public health impact because we are testing an integrated intervention to be carried out by Licensed Practical Nurses (LPNs) that may facilitate its deployment in real world practices with limited resources and competing demands.
The goal of this proposal which grows out of an NIMH Mentored Patient-Oriented Research Career Development (K23) Award is to integrate depression treatment into care for hypertension so that a single program can assist the patients with depression and hypertension. A depression intervention designed to address hypertension, a major factor for CVD, would provide a model for integration of depression treatment with care for other chronic medical conditions among older adults in primary care settings. This project can have a significant public health impact because we are testing an integrated intervention to be carried out by Licensed Practical Nurses (LPNs) that may facilitate its deployment in real world practices with limited resources and competing demands.
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