IMPROVING CARE FOR PANIC DISORDER IN PRIMARY CARE

随着管理式医疗的兴起，作为发现和治疗所有精神健康问题的场所，初级保健机构正变得越来越重要。在这种情况下，恐慌症很普遍，人们对它的认识很差，治疗也不充分。因为它既致残，又经常伪装成各种其他医疗状况，它增加了直接（看医生和不必要的检查）和间接（残疾日）的成本。这是一项多机构合作研究项目，旨在实施一项干预措施，以在初级保健环境中识别和治疗恐慌症，并在一年的时间内研究其临床和成本效益。三个地点（加州大学圣地亚哥分校，加州大学洛杉矶分校，华盛顿大学）将在大学初级保健诊所筛选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模式。患者将被随机分配接受初级保健医生的常规护理或合作护理（CC）。CC采用了认知行为心理治疗（由行为健康专家[BHS]在八周内分六次进行）、专家药物治疗（由BHS向开处方的初级保健医生传达精神科医生的建议）和疾病管理元素（对患者和提供者进行教育和激活，以及通过电话联系进行更仔细的监测和持续的随访）的组合。假设CC将具有优越的临床疗效（以症状减轻、生活质量和功能来衡量）。还假设，虽然CC的直接卫生保健成本将高于常规护理，但间接成本将较低，成本效益分析将支持采用CC作为首选的护理模式。

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.