CALM: Improving Primary Care Anxiety Outcomes

CALM：改善初级保健焦虑结果

基本信息

批准号：
7631289
负责人：
MURRAY B. STEIN
金额：
$ 38.06万
依托单位：
UNIVERSITY OF CALIFORNIA, SAN DIEGO
依托单位国家：
美国
项目类别：
财政年份：
1999
资助国家：
美国
起止时间：
1999-09-21 至 2012-05-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7631289
关键词：
Address Administrator Adult African American Algorithms Anxiety Anxiety Disorders Arkansas Behavior Caring Case Manager Chronic Disease Classification Clinic Clinical Clinical effectiveness Communities Comorbidity Diagnosis Disadvantaged Disease Disease Management Effectiveness Effectiveness of Interventions Evidence based treatment Exclusion Criteria Expectancy Future Generalized Anxiety Disorder Geographic Locations Health Care Costs Healthcare Hispanics Human Resources Individual Intervention Interview Knowledge Learning Mental Health Methods Minority Groups Modeling Outcome Panic Panic Disorder Patient Care Patients Pharmaceutical Preparations Population Heterogeneity Population Study Post-Traumatic Stress Disorders Primary Health Care Provider Public Health Qualitative Methods Quality of Care Randomized Relative (related person)Research Research Personnel Resources Rural Sampling Self Efficacy Series Services Site Study models Substance Use Disorder Substance abuse problem Techniques Testing Therapeutic Universities Work base collaborative care cost effective cost effectiveness depression design ethnic minority population evidence base improved informant member neglect programs response social social stigma therapy design treatment as usual uptake

Address Administrator Adult African American Algorithms Anxiety Anxiety Disorders Arkansas Behavior Caring Case Manager Chronic Disease Classification Clinic Clinical Clinical effectiveness Communities Comorbidity Diagnosis Disadvantaged Disease Disease Management Effectiveness Effectiveness of Interventions Evidence based treatment Exclusion Criteria Expectancy Future Generalized Anxiety Disorder Geographic Locations Health Care Costs Healthcare Hispanics Human Resources Individual Intervention Interview Knowledge Learning Mental Health Methods Minority Groups Modeling Outcome Panic Panic Disorder Patient Care Patients Pharmaceutical Preparations Population Heterogeneity Population Study Post-Traumatic Stress Disorders Primary Health Care Provider Public Health Qualitative Methods Quality of Care Randomized Relative (related person)Research Research Personnel Resources Rural Sampling Self Efficacy Series Services Site Study models Substance Use Disorder Substance abuse problem Techniques Testing Therapeutic Universities Work base collaborative care cost effective cost effectiveness depression design ethnic minority population evidence base improved informant member neglect programs response social social stigma therapy design treatment as usual uptake

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项目摘要

DESCRIPTION (provided by applicant): Although it is now well established that collaborative, chronic disease management approaches are clinically and cost effective for treating depression in primary care, we know very little about how such models perform for anxiety disorders, which occur more commonly than depression in primary care and are particularly difficult to manage. To address this gap, we propose the first large-scale effectiveness study to test a collaborative care approach to treating primary care anxiety. This work builds directly on our Collaborative Care for Panic study, key informant interviews of clinicians, patients and clinic administrators, and more recent studies in primary care depression. Based on these considerations, we have developed a single, specially designed intervention called CALM (Coordinated Anxiety Learning and Management), that can deliver evidence-based treatment to patients with any of four anxiety disorders prevalent in primary care (Panic Disorder [PD], Generalized Anxiety Disorder [GAD], Social Anxiety Disorder [SAD], and Posttraumatic Stress Disorder [PTSD]), including those patients with comorbid depression and/or moderate substance abuse. This intervention allows patients treatment choice (CBT and/or medication), uses techniques to maximize patient engagement, and includes stepped care algorithms - approaches successfully employed in large-scale studies of primary care depression. We have also included an ethnically diverse study population, as well as Spanish-speaking patients, and propose qualitative studies to better understand how CALM should be tailored to individual clinics and to examine the acceptability of CALM for disadvantaged patients. These qualitative studies will provide valuable information needed for future dissemination of this approach. The primary aims are: (1) to use experimental, quantitative methods to determine the clinical effectiveness of CALM compared to treatment as usual (TAD) for the above four anxiety disorders (as a group and individually) and to compare CALM and TAU in terms of intermediate outcomes such as quality of care, self-efficacy, and social stigma; and (2) to use qualitative methods to assess acceptability and barriers to sustainability of CALM in participating clinics, providers, and patients. The secondary aims are: (1) to use quasi-experimental methods (e.g. instrumental variables) to examine the effects of appropriate treatment, independent of intervention assignment, on functioning and other clinical outcomes; and (2) to estimate health care costs and cost effectiveness of CALM.

描述（由申请人提供）：尽管现在已经很好地确定，协作，慢性疾病管理方法在临床上和成本效益用于治疗初级保健的抑郁症，但我们对这种模型的焦虑症的表现知之甚少，焦虑症的表现比初级保健中的抑郁症更常见，并且尤其难以管理。为了解决这一差距，我们提出了第一项大规模有效性研究，以测试治疗初级保健焦虑的协作护理方法。这项工作直接建立在我们的恐慌研究，临床医生，患者和诊所管理员的主要线人访谈以及初级保健抑郁症研究的基础上。基于这些考虑，我们开发了一种专门设计的干预措施，称为平静（协调的焦虑学习和管理），可以为患有四种焦虑症患者中的任何一种循证治疗（恐慌症[PD]，普遍焦虑症]，社交焦虑症[SAD]，SAD]和经常性压力障碍[PTSD]施加滥用，包括抑郁症和抑郁症。这种干预措施允许患者选择（CBT和/或药物），使用技术最大化患者参与度，并包括阶梯护理算法 - 成功地用于初级保健抑郁症的大规模研究中。我们还包括了一个种族多样化的研究人群以及讲西班牙语的患者，并提出定性研究，以更好地了解如何对个别诊所量身定制平静，并检查对处境不利的患者的平静的可接受性。这些定性研究将提供未来传播这种方法所需的宝贵信息。主要目的是：（1）使用实验性的定量方法来确定与往常一样（TAD）相比，对以上四种焦虑症（作为一个组和单独）的治疗（TAD）相比，并根据诸如护理质量，自我效能感和社会污名等中等结果的平静和TAU进行比较；（2）使用定性方法来评估参与诊所，提供者和患者中镇定可持续性的可接受性和障碍。次要目的是：（1）使用准实验方法（例如工具变量）来检查适当治疗，独立于干预分配，功能和其他临床结果的影响；（2）估计镇静的医疗保健成本和成本效益。