Impact of Collaborative Care for Underserved Patients with PTSD in Primary Care: a Randomized Controlled Trial
Impact of Collaborative Care for Underserved Patients with PTSD in Primary Care: a Randomized Controlled Trial
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DOI：
10.1007/s11606-016-3588-3
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发表时间：
2016-05-01
影响因子：
5.7
通讯作者：
Tobin, Jonathan N.
中科院分区：
文献类型：
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作者：
Meredith, Lisa S.;Eisenman, David P.;Tobin, Jonathan N.
心理健康问题的协作护理的有效性是明确的抑郁症和成长，但混合焦虑症，包括创伤后应激障碍（PTSD）。我们对合作护理在服务低收入患者的环境中是否有效知之甚少，例如联邦合格卫生中心（FATHCs）。我们比较了最低限度增强常规护理（MEU）与与护理经理（PCM）合作护理PTSD的有效性。这是一项多方面的研究。一项为期1年的PTSD护理改善的现场患者随机对照试验。我们从2010年6月至2012年10月招募并入组了6个PTSD护理中心的404名患者。如果患者有初级保健预约，没有明显的身体或认知障碍参与，年龄在18-65岁，计划在研究地点继续护理1年，并符合过去一个月PTSD. Main结果的诊断标准PTSD诊断和症状严重程度（范围，0-136）的基础上，临床医生管理的PTSD量表（CAPS）。次要结果是心理健康问题的药物治疗和咨询，以及基线、6个月和12个月时评估的健康相关生活质量。在12个月时，PCM患者和MEU患者的PTSD诊断绝对下降了56.7%和60.6%。PTSD症状分别下降了26.8和24.2分。MEU和PCM患者在护理结果或健康相关生活质量方面也没有差异。实际参与护理管理的患者比未参与护理管理的患者精神卫生保健就诊率高14%（p <0.01），精神卫生药物处方率高15.2%（p < 0.01）。
The effectiveness of collaborative care of mental health problems is clear for depression and growing but mixed for anxiety disorders, including posttraumatic stress disorder (PTSD). We know little about whether collaborative care can be effective in settings that serve low-income patients such as Federally Qualified Health Centers (FQHCs).We compared the effectiveness of minimally enhanced usual care (MEU) versus collaborative care for PTSD with a care manager (PCM).This was a multi-site patient randomized controlled trial of PTSD care improvement over 1 year.We recruited and enrolled 404 patients in six FQHCs from June 2010 to October 2012. Patients were eligible if they had a primary care appointment, no obvious physical or cognitive obstacles to participation, were age 18-65 years, planned to continue care at the study location for 1 year, and met criteria for a past month diagnosis of PTSD.The main outcomes were PTSD diagnosis and symptom severity (range, 0-136) based on the Clinician-Administered PTSD Scale (CAPS). Secondary outcomes were medication and counseling for mental health problems, and health-related quality of life assessed at baseline, 6 months, and 12 months.Patients in both conditions improved similarly over the 1-year evaluation period. At 12 months, PTSD diagnoses had an absolute decrease of 56.7 % for PCM patients and 60.6 % for MEU patients. PTSD symptoms decreased by 26.8 and 24.2 points, respectively. MEU and PCM patients also did not differ in process of care outcomes or health-related quality of life. Patients who actually engaged in care management had mental health care visits that were 14 % higher (p < 0.01) and mental health medication prescription rates that were 15.2 % higher (p < 0.01) than patients with no engagement.A minimally enhanced usual care intervention was similarly effective as collaborative care for patients in FQHCs.