IMPROVING CARE FOR PANIC DISORDER IN PRIMARY CARE

随着管理型保健的兴起，初级保健环境作为检测和治疗所有精神健康问题的场所正变得越来越重要。在这种情况下，恐慌症很普遍，没有得到充分的认识，也没有得到充分的治疗。由于它既是致残的，又经常伪装成各种其他医疗条件，它既增加了直接成本(医生就诊和不必要的测试)，也增加了间接成本(残疾日)。这是一个多机构合作研究项目，旨在实施一项干预措施，以识别和治疗初级保健环境中的恐慌症，并在一年内研究其临床和成本效益。三个网站(UCSD，UCLA，UW)将在一所大学初级保健诊所筛查和识别患有恐慌症的患者，并在这种情况下测试一种创新的恐慌症服务提供模式。患者将被随机分为两组，要么照常接受他们的初级保健医生的护理，要么接受协作护理(CC)。CC采用了认知-行为心理治疗(由行为健康专家[BHS]在八周内进行六次会议)、专家药物治疗(由BHS向开处方的初级保健医生传达精神病学家的建议)和疾病管理元素(教育和激活患者和提供者，以及通过电话联系在下一年进行更仔细的监测和持续跟踪)的组合。据推测，CC将具有更好的临床疗效(根据症状减轻、生活质量和功能来衡量)。还假设，尽管CC的直接保健费用将高于常规保健，但间接费用将更低，成本效益分析将支持采用CC作为首选保健模式。

With the rise of managed care, the primary care setting is assuming increasing importance as a site for the detection and treatment of all mental health problems. In this setting, panic disorder is prevalent, poorly recognized, and inadequately treated. Because it is both disabling and often masquerades as a variety of other medical conditions, it increases both direct (physician visits and unnecessary testing) and indirect (disability days) costs. This is a multi-institutional collaborative research project designed to implement an intervention to identify and treat panic disorder in the primary care setting and to study its clinical and cost effectiveness over a one-year period. Three sites (UCSD, UCLA, UW) will screen and identify patients in a university primary care clinic who suffer from panic disorder and test an innovative model of service delivery for panic disorder in this setting. Patients will be randomized to receive either care as usual from their primary care physician or collaborative care (CC). CC employs a combination of cognitive-behavioral psychotherapy (delivered in six sessions over eight weeks by a behavioral health specialist [BHS]), expert pharmacotherapy (guided by a psychiatrist's recommendations relayed by the BHS to the prescribing primary care physician), and disease management elements (education and activation of patient and provider and more careful monitoring and sustained follow-up over the next year via phone contact). It is hypothesized that CC will have superior clinical effectiveness (measured in terms of symptom reduction, quality of life, and function). It is also hypothesized that although direct health care costs will be higher for CC than for usual care, indirect costs will be lower and cost-effectiveness analysis will support the adoption of CC as a preferred model of care.