Moderators and predictors of clinical outcome in a randomized trial for behavior problems in pediatric primary care.
Moderators and predictors of clinical outcome in a randomized trial for behavior problems in pediatric primary care.
复制标题
儿科初级保健行为问题随机试验中临床结果的调节因素和预测因素。
DOI：
10.1093/jpepsy/jsr006
复制
发表时间：
2011
影响因子：
3.6
通讯作者：
Kelleher,Kelly
中科院分区：
文献类型：
--
作者：
Kolko,DavidJ;Cheng,Yu;Campo,JohnV;Kelleher,Kelly
目的 评估与临床试验中三个结果相关的假定调节因子、预测因子和治疗参数变量，该临床试验比较了针对初级保健中儿科行为问题的现场护士管理干预 (PONI) 和强化常规护理 (EUC) 的模块化方案。方法患者是六个初级保健办公室中因行为问题而临床转诊的 163 名儿童。 PONI 由七个治疗模块组成，这些模块改编自之前针对该人群的治疗试验，而 EUC 则涉及到社区提供者的便利转诊。结果测量基于标准化量表，反映一种家长评定的总体（儿童功能障碍）和一种儿童评定的总体（儿童健康），以及对两名知情者的诊断访谈（对立违抗性障碍的缓解）。 结果主持人分析显示，经过 12 个月的随访，在白人儿童中，PONI 在减少儿童功能障碍方面比 EUC 更有效，而在非白人儿童中，EUC 比 PONI 更有效。在完整样本中，儿童健康状况的改善是通过儿童抑郁和焦虑的严重程度以及家庭冲突的程度来预测的。儿童接受 PONI 认知行为治疗的持续时间与儿童整体健康状况的更大改善有关，但其他治疗参数与结果无关。 结论 尽管有研究结果，但这些少数显着关系表明，这两种治疗对多个结果以及选定的儿童、父母、家庭和治疗变量具有强大的影响。研究结果扩大了将心理健康服务纳入儿科实践的努力。
ObjectivesTo evaluate putative moderator, predictor, and treatment parameter variables in relation to three outcomes in a clinical trial that compared a modular protocol for on-site, nurse-administered intervention (PONI) and enhanced usual care (EUC) for pediatric behavioral problems in primary care.MethodsPatients were 163 clinically referred children for behavior problems in six primary care offices. PONI consisted of seven treatment modules adapted from prior treatment trials with this population, whereas EUC involved a facilitated referral to a community provider. Outcome measures were based on standardized scales reflecting one parent-rated aggregate (child dysfunction) and one child-rated aggregate (child health), and diagnostic interviews with both informants (remission in oppositional defiant disorder).ResultsModerator analyses revealed that PONI was more effective than EUC in reducing child dysfunction by 12-month follow-up among Caucasian children, whereas EUC was more effective than PONI among non-Caucasian children. In the full sample, child health improvement was predicted by the severity of the child’s depression and anxiety, and level of family conflict. Duration of child exposure to cognitive-behavioral treatment in PONI was related to greater improvement in overall child health, but other treatment parameters were unrelated to outcome.ConclusionsThese few significant relationships notwithstanding the findings indicate that the two treatments had robust effects on several outcomes and across selected child, parent, family, and treatment variables. The findings extend efforts to incorporate mental health services in pediatric practice.