Telepsychiatrists' Medication Treatment Strategies in the Children's Attention-Deficit/Hyperactivity Disorder Telemental Health Treatment Study.
Telepsychiatrists' Medication Treatment Strategies in the Children's Attention-Deficit/Hyperactivity Disorder Telemental Health Treatment Study.
复制标题
儿童注意力缺陷/多动症远程心理健康治疗研究中远程精神科医生的药物治疗策略。
DOI：
10.1089/cap.2015.0017
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发表时间：
2016
影响因子：
1.9
通讯作者：
Myers,Kathleen
中科院分区：
文献类型：
--
作者：
Rockhill,CarolM;Tse,YuetJuhn;Fesinmeyer,MeganD;Garcia,Jessica;Myers,Kathleen
目的：本研究的目的是检查处方策略，远程精神科医生用于提供药物治疗的儿童注意力缺陷/多动障碍（ADHD）Telemental健康治疗研究（CATTS）。方法：CATTS是一项随机对照试验，证明了优势的远程医疗服务提供模式治疗ADHD与药物治疗和行为训练相结合（n=111），与管理在初级保健增强与远程精神病学咨询（n =112）。ADHD的诊断采用儿童计算机诊断访谈表（CDISC），对立违抗性障碍（ODD）和焦虑症（AD）的共病关系采用CDISC和儿童行为检查表。远程精神科医生使用德克萨斯州儿童药物算法项目（TCMAP）来指导药物治疗和治疗目标模型，以鼓励他们自信的药物管理，以达到ADHD相关症状减少50%的预定目标。我们评估了是否telepsychiatrists的决策作出改变药物治疗与基线ADHD症状的严重程度，合并症，并达到治疗目标的目标goal.Results：Telepsychiatrists表现出高度的保真度（91%），他们选择的算法在药物管理。在试验结束时，CATTS干预显示，46.0%的治疗目标达到了目标，而增强的初级保健条件下为13.6%，并且ADHD合并症状态与两种合并症组的目标实现率显着更高。远程精神科医生更有可能决定对基线ADHD严重程度较高的青少年以及与ADHD共病的疾病进行药物调整。多重混合方法回归分析控制基线ADHD的严重程度和合并症的状态表明，远程精神科医生还根据他们的决策会议，以达到治疗目标的目标goal.Conclusions：远程精神病学是一种有效的服务提供模式，为ADHD提供药物治疗，和CATTS远程精神科医生表现出高度的保真度，以证据为基础的协议。
Objective:The purpose of this study was to examine the prescribing strategies that telepsychiatrists used to provide pharmacologic treatment in the Children's Attention-Deficit/Hyperactivity Disorder (ADHD) Telemental Health Treatment Study (CATTS).Methods:CATTS was a randomized controlled trial that demonstrated the superiority of a telehealth service delivery model for the treatment of ADHD with combined pharmacotherapy and behavior training (n=111), compared with management in primary care augmented with a telepsychiatry consultation (n=112). A diagnosis of ADHD was established with the Computerized Diagnostic Interview Schedule for Children (CDISC), and comorbidity for oppositional defiant disorder (ODD) and anxiety disorders (AD) was established using the CDISC and the Child Behavior Checklist. Telepsychiatrists used the Texas Children's Medication Algorithm Project (TCMAP) for ADHD to guide pharmacotherapy and the treat-to-target model to encourage their assertive medication management to a predetermined goal of 50% reduction in ADHD-related symptoms. We assessed whether telepsychiatrists' decision making about making medication changes was associated with baseline ADHD symptom severity, comorbidity, and attainment of the treat-to-target goal.Results:Telepsychiatrists showed high fidelity (91%) to their chosen algorithms in medication management. At the end of the trial, the CATTS intervention showed 46.0% attainment of the treat-to-target goal compared with 13.6% for the augmented primary care condition, and significantly greater attainment of the goal by comorbidity status for the ADHD with one and ADHD with two comorbidities groups. Telepsychiatrists' were more likely to decide to make medication adjustments for youth with higher baseline ADHD severity and the presence of disorders comorbid with ADHD. Multiple mixed methods regression analyses controlling for baseline ADHD severity and comorbidity status indicated that the telepsychiatrists also based their decision making session to session on attainment of the treat-to-target goal.Conclusions:Telepsychiatry is an effective service delivery model for providing pharmacotherapy for ADHD, and the CATTS telepsychiatrists showed high fidelity to evidence-based protocols.