Treating Late-Life GAD in Primary Care

在初级保健中治疗晚年广泛性焦虑症

• 批准号: 6802340
• 负责人: MELINDA A STANLEY
• 金额: $ 50万
• 依托单位: BAYLOR COLLEGE OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 1996
• 资助国家: 美国
• 起止时间: 1996-09-01 至 2007-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6802340
• 关键词: aging; anxiety disorders; behavioral /social science research tag; clinical research; cognitive behavior therapy; depression; fear; functional ability; group therapy; human old age (65+); human subject; human therapy evaluation; longitudinal human study; patient oriented research; primary care physician; quality of life; questionnaires

DESCRIPTION (provided by applicant): This application is a revised application for a competing renewal of an ongoing clinical trial of cognitive behavior therapy (CBT) in older adults with generalized anxiety disorder (GAD) (R01-MH53932). Data from the original funding period support the efficacy of CBT for this cohort. The next step in this program of research is to test the outcome of similar treatment procedures in primary care settings where older adults already are receiving medical care. The proposed project is a randomized hybrid efficacy-effectiveness study designed to examine the utility of CBT, relative to Usual Care (UC), for GAD among medical patients age 60 years or older. As the initial test of CBT outcomes for older anxious adults in primary care, the study represents a first step beyond the classic clinical trial. In the proposed study, 150 medical patients, age 60 and older, whose symptoms meet DSM-IV criteria for GAD (APA, 1994) will be recruited through internal medicine, family practice, and geriatric clinics within two large managed care practices in the Houston metropolitan area, The Kelsev-Sevbold Clinic and MacGregor Medical Association. Patients will be assigned randomly to CBT or UC. CST will be conducted on an individual basis, preferably at the clinic site, although arrangements can be made to provide service in the patient's home. Treatment will occur for at least 8 sessions, with additional sessions scheduled for patients with immediate crises or those who need additional time to learn coping skills. Booster sessions will be offered at all follow-up appointments. Patients assigned to UC will continue to receive regular treatment from health care providers. Given a projected attrition rate of 30%, 106 patients (53 per group) are expected to be available for post-treatment and follow-up analyses. Assessments will be conducted at pre- and post-treatment, as well as at 3-, 6-, 9-, and 12-month follow-up. The effects of CBT at post-treatment will address clinical, functional, and satisfaction outcomes. Clinical outcomes will assess target symptoms (worry, anxiety) and coexistent symptoms (depression, sleep, alcohol use). Functional outcomes will assess functional status and quality of life. Satisfaction outcomes will assess patient satisfaction with CBT and general health care. The long-term effects of treatment will be assessed over a one-year period and will target clinical, functional, and satisfaction outcomes, as well as the impact of treatment on service utilization. Service utilization will encompass frequency of visits for physical and emotional problems, frequency of referrals for mental health care, type and frequency of medical tests and procedures, andmedication use. In addition to evaluation of outcomes, the study also will allow preliminary examination of treatment response predictors at both post-treatment and over follow-up.

描述（由申请人提供）：此申请是对正在进行的认知行为治疗临床试验（CBT）的竞争性申请的修订申请。原始资金期的数据支持CBT对此队列的功效。该研究计划的下一步是在老年人已经接受医疗服务的初级保健环境中测试类似治疗程序的结果。拟议的项目是一项随机混合效能效应研究，旨在检查60岁以上的医学患者中的GAD相对于常规护理（UC）的效用。作为对初级保健老年焦虑成年人的CBT结局的初步测试，该研究代表了超出经典临床试验的第一步。在拟议的研究中，将在休斯顿大都市地区的两个大型管理医疗诊所内招募150名60岁及60岁的医学患者，其症状符合GAD的DSM-IV标准（APA，1994年）。患者将被随机分配到CBT或UC。 CST将以单独的基础（最好是在诊所现场进行），尽管可以安排在患者家中提供服务。治疗将至少进行8个课程，并安排额外的危机患者或需要额外时间学习应对技巧的患者进行额外的课程。助推器会议将在所有后续约会中提供。分配给UC的患者将继续接受医疗保健提供者的定期治疗。鉴于预计的损耗率为30％，预计将有106名患者（每组53例）进行治疗和随访分析。评估将在治疗前和后期进行，以及3个，6、9和12个月的随访。 CBT在治疗后的影响将解决临床，功能和满意度结果。临床结果将评估目标症状（忧虑，焦虑）和共存的症状（抑郁，睡眠，饮酒）。功能结果将评估功能状况和生活质量。满意度结果将评估患者对CBT和一般医疗保健的满意度。治疗的长期影响将在一年的时间内评估，并将针对临床，功能和满意度结果，以及治疗对服务利用的影响。服务利用将包括访问频率的身体和情绪问题，精神卫生保健的转诊频率，医疗测试和程序的类型和频率以及使用。除了评估结果外，该研究还将允许对治疗后和过度随访的治疗反应预测因子进行初步检查。