Enhancing the Capacity of Pediatric Primary Care Providers: A Pilot Trial of Anxiety Action Plan

增强儿科初级保健提供者的能力：焦虑行动计划试点

基本信息

批准号：
10574022
负责人：
Golda Susan Ginsburg
金额：
$ 26.69万
依托单位：
UNIVERSITY OF CONNECTICUT SCH OF MED/DNT
依托单位国家：
美国
项目类别：
财政年份：
2023
资助国家：
美国
起止时间：
2023-02-01 至 2026-01-31
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10574022
关键词：
Academy Ache Address Adherence Adult Advisory Committees Age American Anxiety Anxiety Disorders Asthma Attention deficit hyperactivity disorder Behavioral Child Childhood Clinical Treatment Cognitive Therapy Communities Cost-Benefit Analysis Costs and Benefits Development Disease Educational Grants Effectiveness Elements Evidence based intervention Family Feedback Funding Future Goals Health Professional Health Services Accessibility High Prevalence Impairment Intervention Knowledge Location Measures Mediator Medical Mental Health Mental Health Services Mental disorders Methods Modeling National Institute of Mental Health Nurse Practitioners Nurses Office Visits Parents Pediatrics Physician Assistants Prevalence Primary Care Provider Randomized Randomized, Controlled Trials Recommendation Reporting Research Personnel School Nursing Severities Specialist Stomach Surgeon Technology Testing Therapeutic Training United States National Institutes of Health Visit Work Youth anxiety reduction anxious brief intervention childhood anxiety clinical care community setting design disability economic cost effectiveness trial evidence base excessive anxiety follow-up improved innovation medical specialties mental health center novel pediatrician pilot test pilot trial post intervention preventive intervention primary care clinic primary care provider primary care setting primary care visit service delivery service gap service intervention skills theories treatment as usual virtual virtual delivery virtual visit

项目摘要

Anxiety disorders in youth are: 1) the most prevalent psychiatric illnesses, 2) associated with severe disability, and 3) considered gateway disorders--as they predict a broad range of adult psychiatric and functional problems. Despite the high prevalence and impairment, less than half of anxious youth receive mental health services and access to evidenced-based interventions lags far behind that of less common psychiatric illnesses, such as attention deficit hyperactivity disorder. This application addresses this mental health service gap and responds to NIH’s priorities in PAR-MH-21-131: Pilot Effectiveness Trials for Treatment, Preventive and Services Interventions (R34) aimed at testing interventions with previous efficacy in community settings using novel service delivery methods. Specifically, we propose to refine and assess the feasibility of the Anxiety Action Plan (AxAP), a brief intervention to reduce pediatric anxiety, delivered by primary care providers (PCPs; defined here as nurse practitioners, physician assistants, and/or pediatricians) in community pediatric primary care clinics. Primary care settings are ideal for addressing pediatric anxiety specifically because: 1) prevalence rates of excessive anxiety are high in primary care (approximately 10-20%), 2) over 90% of anxious youth report physical complaints (e.g., stomach aches) and are “frequent flyers” in primary care settings, 3) children with, compared to without, medical conditions treated by PCPs are more likely to have elevated anxiety, and 4) PCPs are often the first and only health professional children visit. This proposal builds on the PI’s development and feasibility pilot work with PCPs conducted as part of the NIMH-funded Center for Mental Health in Pediatric Primary Care and with school nurses as part of a Department of Education grant. The AxAP, modeled after the Asthma Action Plan familiar to PCPs, is based on the core element of cognitive behavioral therapy for anxiety (i.e., behavioral exposure), was designed to fit within the short primary care visit (20-30 minutes), can be delivered virtually, is brief (1-4 sessions), and can be billed for as an office visit. Uniquely, and in stark contrast to co-location or integrated models, the goal of the AxAP is to enhance the capacity of PCPs to identify and intervene with anxious youth, which will enhance access to care in general and especially in locations with few mental health specialists. The proposal also incorporates several innovative features including pilot tests of measures to conduct: 1) a cost-benefit analysis of the AxAP and 2) an examination of theory-based target mechanisms at the child, parent and PCP levels. If results of this study are positive, findings would support a large effectiveness trial using an intervention that is ready for dissemination and that could significantly improve clinical care for anxious youth, enhance the capacity of PCPs to identify and reduce anxiety, and lower personal and economic costs associated with pediatric anxiety.

年轻人的焦虑症是：1）最普遍的精神病，2）与严重残疾相关， 3）考虑到门户疾病 - 他们预测了广泛的成人精神病和功能问题。尽管患病率很高和障碍，但不到一半的焦虑年轻人接受了心理健康服务和获得基于经验的干预措施远远落后于较不常见的精神病学疾病，例如注意力缺陷多动障碍。该申请解决了此精神卫生服务差距并回应NIH在PAR-MH-21-131中的优先事项：试验的有效性试验，预防性和服务干预措施（R34）旨在测试以前效率在社区环境中的效率使用新颖的服务交付方法。具体而言，我们建议完善和评估焦虑行动计划（AXAP）是由初级保健提供者提供的简短干预措施，以减少小儿焦虑症（PCPS；在此定义为护士，身体助理和/或儿科医生）在社区小儿初级保健诊所。初级保健环境是针对小儿焦虑的理想选择，特别是因为：1）过度焦虑的患病率在初级保健中很高（约10-20％），2）超过90％的焦虑症青年报告身体投诉（例如，摊位疼痛），是初级保健环境中的“频繁传单”，3）与没有PCP治疗的医疗状况相比，患有PCP治疗的儿童更有可能升高焦虑和4）PCP通常是第一个也是唯一的卫生专业儿童参观。该建议建立在 PI的开发和可行性飞行员与PCP一起工作，作为NIMH资助的心理中心的一部分小儿初级保健和学校护士的健康作为教育部赠款的一部分。这 AXAP以PCP熟悉的哮喘动作计划建模，基于认知的核心元素动画行为疗法（即行为暴露）旨在适合短期访问（20-30分钟）几乎可以交付，是简短的（1-4次会议），可以将其作为办公室访问。独特的，与共同位置或集成模型形成鲜明对比的是，AXAP的目标是增强 PCP识别和干预焦虑青年的能力，这将增强一般的护理机会特别是在很少的心理健康专家的地点。该提案还包含了一些创新的包括进行试验的试验测试在内的功能：1）AXAP的成本效益分析和2）检查基于理论的目标机制在孩子，父母和PCP水平上的检查。如果这项研究的结果是积极的发现将使用准备传播的干预措施支持大型有效试验这可以显着改善焦虑青年的临床护理，增强PCP的能力确定并减少动画，并降低与儿科动画相关的个人和经济成本。