Stepped care versus standard cognitive-behavioral therapy for obsessive-compulsive disorder: a preliminary study of efficacy and costs.
Stepped care versus standard cognitive-behavioral therapy for obsessive-compulsive disorder: a preliminary study of efficacy and costs.
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强迫症的阶梯式护理与标准认知行为疗法：疗效和成本的初步研究。
DOI：
10.1002/da.20804
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发表时间：
2011
影响因子：
7.4
通讯作者：
Gilliam,ChristinaM
中科院分区：
文献类型：
--
作者：
Tolin,DavidF;Diefenbach,GretchenJ;Gilliam,ChristinaM
背景：针对强迫症 (OCD) 的暴露和反应预防 (ERP) 并未得到充分利用，部分原因是成本和时间要求。本研究扩展了试点工作，调查阶梯式护理 ERP 管理的使用，其中患者首先接受低强度、低成本的治疗，而成本更高的干预措施则保留给那些对第一次干预没有反应的患者。方法：30 名患有强迫症的成年人被随机分配接受阶梯式护理 ERP 或标准 ERP。接受阶梯式护理的患者首先进行 3 次为期 6 周的低强度咨询和 ERP 阅读疗法； 6 周后未能满足严格反应者标准的患者接受了治疗师实施的更传统的 ERP 治疗（每周两次 17 次）。接受标准 ERP 的患者接受治疗师实施的 ERP，没有较低强度的导入。结果：两种治疗同样有效，67% 的阶梯护理完成者和 50% 的标准治疗完成者符合治疗后临床显着变化的标准。同样，两组之间的客户满意度评分也没有差异。然而，对治疗成本的检查表明，与标准 ERP 相比，分级护理使患者和第三方付款人的成本显着降低，且效应量较大。结论：这些结果表明，分级护理 ERP 可以显着降低治疗成本，且没有证据表明治疗效果或患者满意度下降。需要进行更多研究来确定强迫症分级护理的长期疗效和成本，并检查在社区环境中实施分级护理的财务和治疗影响。抑郁与焦虑 0:1–10, 2011。 © 2011 Wiley-Liss, Inc.
Background:Exposure and response prevention (ERP) for obsessive–compulsive disorder (OCD) is underutilized, in part because of costs and time requirements. This study extends pilot work investigating the use of a stepped care ERP administration, in which patients are first given a low‐intensity, low‐cost treatment and the more costly intervention is reserved for those who do not respond to the first intervention.Methods:Thirty adults with OCD were randomized to receive stepped care ERP or standard ERP. Those receiving stepped care started with three sessions over 6 weeks of low‐intensity counseling with ERP bibliotherapy; patients failing to meet strict responder criteria after 6 weeks were given the more traditional treatment of therapist‐administered ERP (17 sessions twice weekly). Those receiving standard ERP received the therapist‐administered ERP with no lower‐intensity lead‐in.Results:The two treatments were equally efficacious, with 67% of stepped care completers and 50% of standard treatment completers meeting criteria for clinically significant change at posttreatment. Similarly, no differences in client satisfaction ratings were obtained between the two groups. Examination of treatment costs, however, revealed that stepped care resulted in significantly lower costs to patients and third‐party payers than did standard ERP, with large effect sizes.Conclusions:These results suggest that stepped care ERP can significantly reduce treatment costs, without evidence of diminished treatment efficacy or patient satisfaction. Additional research is needed to determine the long‐term efficacy and costs of stepped care for OCD, and to examine the financial and therapeutic impact of implementing stepped care in community settings. Depression and Anxiety 0:1–10, 2011. © 2011 Wiley‐Liss, Inc.