A randomised controlled trial and economic evaluation of a referrals facilitator between primary care and the voluntary sector
A randomised controlled trial and economic evaluation of a referrals facilitator between primary care and the voluntary sector
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DOI：
10.1136/bmj.320.7232.419
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发表时间：
2000-02-12
影响因子：
--
通讯作者：
Hine, C
中科院分区：
文献类型：
--
作者：
Grant, G;Goodenough, T;Hine, C
目标比较转介到Amalthea项目的患者的结果和资源利用情况，Amalthea项目是一个联络组织，旨在促进志愿组织和初级保健患者之间的联系，与接受常规全科医生护理的患者。设计随机对照试验，随访1个月和4个月。在雅芳设置26个全科诊所。参与者161名患者由他们的全科医生确定为有心理社会问题。主要结果测量主要结果是心理健康（用医院焦虑和抑郁量表评估）和社会支持（用Duke-Barrett功能性社会支持问卷评估）。次要结局是生活质量指标（达特茅斯COOP/WONCA功能健康评估图表和快乐-可怕的面孔量表），与初级保健团队和Amalthea项目联系的费用，初级保健处方的费用，以及转介到其他机构的费用，结果Amalthea组在焦虑方面的改善显著高于对照组。（校正基线后的组间平均差异为-1.9，95%置信区间为-3.0至-0.7），其他情绪感受（平均调整差异-0.5，-0.8至-0.2），进行日常活动的能力（-0.5，-0.8至-0.2），对一般健康的感觉（-0.4，-0.7至-0.1）和生活质量（-0.5，-0.9至-0.1）。在抑郁和感知社会支持方面没有发现差异。平均成本是显着更大的Amalthea手臂比全科医生护理手臂（磅153 V磅133，P = 0.025）。结论转介到Amalthea项目和随后的接触与志愿部门的结果在临床上重要的好处相比，通常的全科医生护理管理心理社会问题，但在更高的成本。
Objectives To compare outcome and resource utilisation among patients referred to the Amalthea Project, a liaison organisation that facilitates contact between voluntary organisations and patients in primary care, with patients receiving routine general practitioner care.Design Randomised controlled trial with follow up at one and four months.Setting 26 general practices in Avon.Participants 161 patients identified by their general practitioner as having psychosocial problems.Main outcome measures Primary outcomes were psychological wellbeing (assessed with the hospital anxiety and depression scale) and social support (assessed using the Duke-UNC functional social support questionnaire). Secondary outcomes were quality of life measures (the Dartmouth COOP/WONCA functional health assessment charts and the delighted-terrible faces scale), cost of contacts with the primary healthcare team and Amalthea Project, cost of prescribing in primary care, and cost of referrals to other agencies, over four months.Results The Amalthea group showed significantly greater improvements in anxiety (average difference between groups after adjustment for baseline -1.9, 95% confidence interval -3.0 to -0.7), other emotional feelings (average adjusted difference -0.5, -0.8 to -0.2), ability to carry out everyday activities (-0.5, -0.8 to -0.2), feelings about general health (-0.4, -0.7 to -0.1), and quality of life (-0.5, -0.9 to -0.1). No difference was detected in depression or perceived social support. The mean cost was significantly greater in the Amalthea arm than the general practitioner care arm (pound 153 v pound 133, P = 0.025).Conclusion Referral to the Amalthea Project and subsequent contact with the voluntary sector results in clinically important benefits compared with usual general practitioner care in managing psychosocial problems, but at a higher cost.