Improving access to care and clinical outcome for pediatric behavioral problems: a randomized trial of a nurse-administered intervention in primary care.
Improving access to care and clinical outcome for pediatric behavioral problems: a randomized trial of a nurse-administered intervention in primary care.
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DOI：
10.1097/dbp.0b013e3181dff307
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发表时间：
2010-06
期刊：
影响因子：
--
通讯作者：
Cheng Y
中科院分区：
文献类型：
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作者：
Kolko DJ;Campo JV;Kelleher K;Cheng Y
确定现场模块化干预相对于加强的常规护理在改善初级保健中有行为问题的儿童获得心理健康服务和结果方面的有效性。来自宾夕法尼亚州匹兹堡大都会六个初级保健办公室的男孩和女孩。 163 名临床转诊儿童在儿科症状清单 17 的外化行为量表上达到适度的临床截止点（第 75 个百分位数），被随机分配到现场护士管理干预 (PONI) 方案或强化常规护理 (EUC) 方案。 PONI 对患有破坏性行为障碍的儿童应用基于证据的专业心理健康治疗的治疗模块，这些模块适合在初级保健机构中提供； EUC 提供诊断评估、建议，并协助转介至社区中的专业心理健康提供者。收集了标准化评级量表，包括 PSC-17、个性化目标行为评级、治疗终止报告和诊断访谈。 PONI 病例接受和完成心理健康服务的可能性明显更高，报告的服务障碍更少，消费者满意度更高，并且在一些临床结果方面显示出较大（尽管不大）的改善，其中包括一年随访中分类行为障碍的缓解。随着时间的推移，这两种情况还报告了一些临床结果的显着改善。由初级保健机构的护士提供的针对行为问题的心理社会干预是可行的，可以改善获得心理健康服务的机会，并且具有一定的临床疗效。提高临床结果的选择包括在儿科实践中使用多方面的协作护理干预措施。
To determine the effectiveness of an on-site modular intervention in improving access to mental health services and outcomes for children with behavioral problems in primary care relative to enhanced usual care. Boys and girls from six primary care offices in metropolitan Pittsburgh, PA. One-hundred and sixty three clinically referred children who met a modest clinical cutoff (75th percentile) on the externalizing behavior scale of the Pediatric Symptom Checklist-17 were randomized to a protocol for on-site, nurse-administered intervention (PONI) or to enhanced usual care (EUC). PONI applied treatment modules from an evidence based specialty mental health treatment for children with disruptive behavior disorders that were adapted for delivery in the primary care setting; EUC offered diagnostic assessment, recommendations, and facilitated referral to a specialty mental health provider in the community. Standardized rating scales, including the PSC-17, individualized target behavior ratings, treatment termination reports, and diagnostic interviews were collected. PONI cases were significantly more likely to receive and complete mental health services, reported fewer service barriers and more consumer satisfaction, and showed greater, albeit modest, improvements on just a few clinical outcomes that included remission for categorical behavioral disorders at one-year follow-up. Both conditions also reported several significant improvements on several clinical outcomes over time. A psychosocial intervention for behavior problems that was delivered by nurses in the primary care setting is feasible, improves access to mental health services, and has some clinical efficacy. Options for enhancing clinical outcome include the use of multifaceted collaborative care interventions in the pediatric practice.