在初级保健中为多种焦虑障碍提供基于证据的治疗:随机对照试验
Peter Roy-Byrne1, Michelle G Craske, Greer Sullivan
1Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine and Harborview Center for Healthcare Improvement for Addictions, Mental Illness, and Medically Vulnerable Populations, Seattle, Washington 98104, USA. roybyrne@u.washington.edu
JAMA
|May 21, 2010
概括
与常规护理相比,协调焦虑学习和管理 (CALM) 模型在初级保健中显著改善了焦虑症状和缓解率. 这种灵活的治疗方法增强了焦虑障碍的心理健康结果.
科学领域:
- 心理健康研究 心理健康研究
- 初级保健干预措施 初级保健干预措施
- 焦虑症治疗方法 焦虑症治疗方法
背景情况:
- 将心理健康干预从研究转化为实践对于提高护理质量至关重要.
- 虽然对抑郁症有进展,但对现实世界的焦虑障碍的研究是有限的.
研究的目的:
- 评估灵活的治疗-交付模型,协调焦虑学习和管理 (CALM) 的有效性,用于初级保健中常见的焦虑障碍.
- 将CALM模型与通常护理 (UC) 进行比较,以改善患者的治疗结果.
主要方法:
- 一项随机对照试验,涉及17个初级保健诊所的1004名患有焦虑症的患者.
- CALM模型提供了灵活的治疗选择 (CBT,药物或两者兼而有之),实时监测结果,并为护理经理提供计算机辅助支持.
- 患者接受了3-12个月的治疗,在6个月,12个月和18个月后进行了随访评估.
主要成果:
- 与UC相比,CALM在6,12和18个月后显示出全球焦虑症状的明显改善.
- 在12个月后,CALM显示出比UC更高的响应率 (63.7%vs44.7%) 和缓解率 (51.5%vs33.3%).
- 治疗反应和缓解所需的患者数量分别约为5.3和5.5.
结论:
- 在初级保健机构治疗焦虑障碍时,CALM模型比常规护理更有效.
- 在18个月内,CALM导致焦虑和抑郁症状,功能障碍和整体护理质量的更大改善.
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