Incremental benefits and cost of coordinated anxiety learning and management for anxiety treatment in primary care.
Incremental benefits and cost of coordinated anxiety learning and management for anxiety treatment in primary care.
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DOI：
10.1017/s0033291711002893
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发表时间：
2012-09
影响因子：
6.9
通讯作者：
Roy-Byrne, P.
中科院分区：
文献类型：
--
作者：
Joesch, J. M.;Sherbourne, C. D.;Sullivan, G.;Stein, M. B.;Craske, M. G.;Roy-Byrne, P.
提高精神卫生保健的质量需要将成功的研究干预措施融入“现实世界”的实践环境。协调焦虑学习和管理（CALM）是一种治疗模式，用于初级保健中遇到的焦虑症。CALM提供认知行为疗法（CBT），药物治疗或两者兼而有之;非专家护理经理协助初级保健临床医生进行依从性促进和药物优化;计算机辅助CBT交付;和结果监测。本研究描述了与常规护理相比，CALM的增量效益、成本和净效益。CALM随机对照有效性试验于2006年至2009年在美国4个城市的17家初级保健诊所进行。在1，062名合格患者中，1，004名年龄在18-75岁之间的英语或西班牙语患者患有恐慌，广泛性焦虑，社交焦虑和/或创伤后应激障碍伴或不伴重度抑郁症。根据基线、6、12和18个月时的盲态电话评估，估计无并发症天数、质量调整生命年（QDs）以及门诊、急诊、住院和精神病药物治疗费用。在18个月的时间里，CALM参与者平均多经历了57.1天的无焦虑日[95%置信区间（CI）31-83]和245美元的额外医疗费用（95% CI $-733至1，223美元）。当无焦虑日价值≥ 4美元时，CALM与常规治疗相比的平均增量净获益为正。对于基于简表健康调查-12和EQ-5D的QIII，平均增量净获益为正值，≥ 5，000美元。与通常的护理相比，CALM提供了显着的好处，在医疗保健支出略有增加。
Improving the quality of mental health care requires integrating successful research interventions into “real-world” practice settings. Coordinated Anxiety Learning and Management (CALM) is a treatment-delivery model for anxiety disorders encountered in primary care. CALM offers cognitive behavioral therapy (CBT), medication, or both; non-expert care managers assisting primary care clinicians with adherence promotion and medication optimization; computer-assisted CBT delivery; and outcome monitoring. This study describes incremental benefits, costs, and net benefits of CALM versus usual care. The CALM randomized, controlled effectiveness trial was conducted in 17 primary care clinics in 4 US cities from 2006 to 2009. Of 1,062 eligible patients, 1,004 English- or Spanish-speaking patients age 18–75 years with panic, generalized anxiety, social anxiety, and/or posttraumatic stress disorder with or without major depression were randomized. Anxiety-free days, quality-adjusted life years (QALYs), and expenditures for outpatient visits, emergency room visits, inpatient stays, and psychiatric medications were estimated based on blinded telephone assessments at baseline, 6, 12, and 18 months. Over 18 months, CALM participants, on average, experienced 57.1 more anxiety-free days [95% confidence interval (CI) 31–83] and $245 additional medical expenses (95% CI $ −733 to $1,223). The mean incremental net benefit of CALM versus usual care was positive when an anxiety-free day was valued ≥ $4. For QALYs based on the Short-Form Health Survey-12 and the EQ-5D the mean incremental net benefit was positive at ≥ $5,000. Compared with usual care, CALM provides significant benefits with modest increases in health care expenditures.