Effectiveness of a unified transdiagnostic treatment in routine clinical care

描述（由申请人提供）：焦虑和情绪诊断是慢性的，对个人和医疗保健系统的成本具有破坏性，并且比任何其他类型的疾病更普遍。当这些疾病同时出现时，严重的公共卫生影响和社会成本就会加剧。尽管治疗方案之间的共病率和潜在的机制相似性很高，但传统上建议对这些障碍的单一障碍循证心理治疗方案按顺序治疗情绪障碍。此外，当临床医生面对复杂的病例介绍时，他们往往没有做好治疗的准备，并远离循证方法，这可能会增加精神卫生系统的负担。情绪障碍跨诊断治疗统一协议（UP）是一种创新的跨诊断协议，具有成功治疗情绪障碍的有希望的证据，无论是独立的还是共病的表现，包括未另行指定（NOS）障碍的分类。到目前为止，只有UP的疗效试验，这限制了普遍性，并且没有解决常规临床护理环境中精神和医学合并症的更大公共卫生影响和有效性。为了解决这一关键限制，申请人提出了试点可行性、可接受性和 UP在不同精神和医学合并症患者中对医院内手动支持治疗的耐受性研究。以部署为中心的模型（DFM）将为设计和统计分析提供信息。另一个目的包括通过调查和采访通过研究实施UP的系统中的利益相关者，确定UP在临床环境中的可行性、可接受性、感知适合性和满意度。与利益相关者协商可以最大限度地减少在更大的系统内收集和评估适合性所需的时间，因此，最大限度地减少常规护理环境中科学与实践之间的时滞。本研究通过检查UP在新人群中作为常规护理环境中治疗常见和衰弱性精神障碍的策略的有效性，解决了一个重要的公共卫生问题。此外，拟议的研究目标将补充一个全面的培训计划，以准备申请人成为一个独立的调查员，在执行科学和有效性研究的专业知识。这项研究的结果将提供重要的信息，说明这种有效的治疗方法是否有效、高效，并准备在精神和医学合并症常见的常规护理环境中实施。这项研究也将作为一个模型部署到全科诊所的有效治疗。

DESCRIPTION (provided by applicant): Anxiety and mood diagnoses are chronic and devastating with respect to costs to the individual and the healthcare system, and are more prevalent than any other class of disorders. When these disorders present concurrently, the significant public health implications and societal costs are intensified. Despite high rates of comorbidity and underlying mechanistic similarities between treatment protocols, single disorder evidence- based psychotherapy protocols for these disorders have traditionally been recommended to treat emotional disorders sequentially. Moreover, when clinicians are presented with complex case presentations, they are often unprepared to treat them and move away from evidence-based approaches, potentially increasing the burden on the mental health system. The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP) is an innovative transdiagnostic protocol with promising evidence for successful treatment of emotional disorders, both for standalone and comorbid presentations, including the classification of not otherwise specified (NOS) disorders. To date, there have only been efficacy trials of the UP, which limit generalizability and do not address the larger public health impact and effectiveness in routine clinical care settings with both psychiatric and medical comorbidity. To address this critical limitation, the applicant proposes a pilot feasibility, acceptability, and tolerability study of the UP in patients with diverse psychiatric and medical comorbidity to manualized supportive therapy within a hospital. The deployment focused model (DFM) will inform design and statistical analyses. An additional aim includes determining the feasibility, acceptability, perceived fit and satisfaction of the UP in clinic settings through surveying and interviewing stakeholders in the system that are implementing the UP through the study. Consultation with stakeholders can minimize the time required to collect and assess fit within the larger system and, therefore, minimizes the time lag between science and practice in routine care settings. This study addresses an important public health concern by examining the effectiveness of the UP in a new population as a strategy for treatment of common and debilitating mental disorders in routine care settings. Furthermore, the proposed research aims will complement a comprehensive training plan to prepare the applicant to become an independent investigator with expertise in implementation science and effectiveness research. Results from the study will provide important information about whether or not this efficacious treatment can be effective, efficient, and ready for implementation in routine care settings in which psychiatric and medical comorbidity are common. This study will also serve as a model of deploying efficacious treatments into generalist clinics.