Improving access to psychological therapies: Phase IV prospective cohort study
Improving access to psychological therapies: Phase IV prospective cohort study
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DOI：
10.1348/014466509x405178
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发表时间：
2009-11-01
影响因子：
3.1
通讯作者：
Suckling, Rupert
中科院分区：
文献类型：
--
作者：
Richards, David A.;Suckling, Rupert
目标.目的：探讨在常规实践中采用协作护理实施模式对焦虑和抑郁患者实施阶梯式循证护理的效果。观察性前瞻性队列研究/IV期田间试验。我们从2006年8月起使用PHQ-9和GAD-7收集了一个前瞻性队列的3,994名连续患者的抑郁和焦虑数据，这些患者被转介到英国唐卡斯特的改善获得心理治疗示范点12个月。我们收集了人口统计和过程信息，包括接受的治疗类型和方法。我们计算了竞争治疗的患者和退出或被认为不适合的患者的效应量、缓解率和恢复率。2 795名患者接受了评估，其中2 017人接受了两次或两次以上的预约。其中，869人在普查日期前完成了治疗，743人仍在接受治疗，319人退出，85人被发现不适合。完成治疗的患者中焦虑和抑郁的治疗前后效应量分别为1.39和1.41，治疗后抑郁和焦虑的相对风险分别为0.29和0.34。抑郁和焦虑的缓解和恢复率分别为76%和74%。平均治疗次数为5.15，平均时间为2小时45分钟。平均而言，患者通过电话至少收到三次此类联系。结果与基准试验、综述和常规试验相当。将低强度阶梯式护理心理治疗与基于电话的协作护理组织系统相结合，可以在常规实践中取得良好的临床效果。
Objectives. To determine the effects of implementing stepped care evidence-based psychological treatments for anxiety and depression in routine practice using a collaborative care implementation model.Design. Observational prospective cohort study/Phase IV field trial.Methods. We collected data on depression and anxiety from a prospective cohort of 3,994 consecutive patients referred to the UK Improving Access to Psychological Therapies demonstration site in Doncaster for 12 months from August 2006 using PHQ-9 and GAD-7. We collected demographic and process information including the type and methods of treatments received. We calculated effect sizes, remission, and recovery rates for patients competing treatment and those who dropped out or were considered to be unsuitable.Results. Two thousand seven hundred and ninety-five patients received an assessment, out of which 2,017 received two or more appointments. Out of these, 869 had completed treatment by the census date, 743 remained in treatment, 319 had dropped out, and 85 had been found to be unsuitable. Pre-post treatment effect sizes for anxiety and depression in those patients completing treatment were 1.39 and 1.41, respectively, with post-treatment relative risks of depression and anxiety 0.29 and 0.34. The combined remission and recovery rates were 76% for depression and 74% for anxiety. The mean number of treatment sessions was 5.15 in a mean time of 2 h and 45 min. On an average, patients received at least three of these contacts by telephone. Outcomes are comparable with benchmarked trials, reviews, and routine datasets.Conclusions. Combining low-intensity stepped care psychological treatment with a telephony-based collaborative care organizational system can deliver good clinical outcomes in routine practice.