Enhancing the Capacity of Pediatric Primary Care Providers: A Pilot Trial of Anxiety Action Plan

增强儿科初级保健提供者的能力：焦虑行动计划试点

• 批准号: 10574022
• 负责人: Golda Susan Ginsburg
• 金额: $ 26.69万
• 依托单位: UNIVERSITY OF CONNECTICUT SCH OF MED/DNT
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-02-01 至 2026-01-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10574022
• 关键词: Academy; Ache; Address; Adherence; Adult; Advisory Committees; Age; American; Anxiety; Anxiety Disorders; Asthma; Attention deficit hyperactivity disorder; Behavioral; Child; Childhood; Clinical Treatment; Cognitive Therapy; Communities; Cost-Benefit Analysis; Costs and Benefits; Development; Disease; Educational Grants; Effectiveness; Elements; Evidence based intervention; Family; Feedback; Funding; Future; Goals; Health Professional; Health Services Accessibility; High Prevalence; Impairment; Intervention; Knowledge; Location; Measures; Mediator; Medical; Mental Health; Mental Health Services; Mental disorders; Methods; Modeling; National Institute of Mental Health; Nurse Practitioners; Nurses; Office Visits; Parents; Pediatrics; Physician Assistants; Prevalence; Primary Care; Provider; Randomized; Randomized, Controlled Trials; Recommendation; Reporting; Research Personnel; School Nursing; Severities; Specialist; Stomach; Surgeon; Technology; Testing; Therapeutic; Training; United States National Institutes of Health; Visit; Work; Youth; anxiety reduction; anxious; brief intervention; childhood anxiety; clinical care; community setting; design; disability; economic cost; effectiveness trial; evidence base; excessive anxiety; follow-up; improved; innovation; medical specialties; mental health center; novel; pediatrician; pilot test; pilot trial; post intervention; preventive intervention; primary care clinic; primary care provider; primary care setting; primary care visit; service delivery; service gap; service intervention; skills; theories; treatment as usual; virtual; virtual delivery; virtual visit

Anxiety disorders in youth are: 1) the most prevalent psychiatric illnesses, 2) associated with severe disability, and 3) considered gateway disorders--as they predict a broad range of adult psychiatric and functional problems. Despite the high prevalence and impairment, less than half of anxious youth receive mental health services and access to evidenced-based interventions lags far behind that of less common psychiatric illnesses, such as attention deficit hyperactivity disorder. This application addresses this mental health service gap and responds to NIH’s priorities in PAR-MH-21-131: Pilot Effectiveness Trials for Treatment, Preventive and Services Interventions (R34) aimed at testing interventions with previous efficacy in community settings using novel service delivery methods. Specifically, we propose to refine and assess the feasibility of the Anxiety Action Plan (AxAP), a brief intervention to reduce pediatric anxiety, delivered by primary care providers (PCPs; defined here as nurse practitioners, physician assistants, and/or pediatricians) in community pediatric primary care clinics. Primary care settings are ideal for addressing pediatric anxiety specifically because: 1) prevalence rates of excessive anxiety are high in primary care (approximately 10-20%), 2) over 90% of anxious youth report physical complaints (e.g., stomach aches) and are “frequent flyers” in primary care settings, 3) children with, compared to without, medical conditions treated by PCPs are more likely to have elevated anxiety, and 4) PCPs are often the first and only health professional children visit. This proposal builds on the PI’s development and feasibility pilot work with PCPs conducted as part of the NIMH-funded Center for Mental Health in Pediatric Primary Care and with school nurses as part of a Department of Education grant. The AxAP, modeled after the Asthma Action Plan familiar to PCPs, is based on the core element of cognitive behavioral therapy for anxiety (i.e., behavioral exposure), was designed to fit within the short primary care visit (20-30 minutes), can be delivered virtually, is brief (1-4 sessions), and can be billed for as an office visit. Uniquely, and in stark contrast to co-location or integrated models, the goal of the AxAP is to enhance the capacity of PCPs to identify and intervene with anxious youth, which will enhance access to care in general and especially in locations with few mental health specialists. The proposal also incorporates several innovative features including pilot tests of measures to conduct: 1) a cost-benefit analysis of the AxAP and 2) an examination of theory-based target mechanisms at the child, parent and PCP levels. If results of this study are positive, findings would support a large effectiveness trial using an intervention that is ready for dissemination and that could significantly improve clinical care for anxious youth, enhance the capacity of PCPs to identify and reduce anxiety, and lower personal and economic costs associated with pediatric anxiety.

青少年焦虑症包括：1) 最常见的精神疾病，2) 与严重残疾相关， 3) 考虑了网关障碍——因为它们预测了广泛的成人精神和功能障碍 问题。尽管焦虑青少年的患病率和损害程度很高，但只有不到一半的人接受了心理健康治疗 服务和获得循证干预措施的机会远远落后于不太常见的精神病学 疾病，例如注意力缺陷多动障碍。该应用程序致力于提供心理健康服务 差距并响应 NIH 在 PAR-MH-21-131 中的优先事项：治疗、预防的试点有效性试验 和服务干预措施（R34），旨在测试社区环境中以前的干预措施的有效性 使用新颖的服务提供方法。具体来说，我们建议完善并评估该方案的可行性 焦虑行动计划 (AxAP)，由初级保健提供者提供的一项旨在减少儿科焦虑的简短干预措施 （PCP；此处定义为执业护士、医师助理和/或儿科医生）社区儿科 初级保健诊所。初级保健机构是解决儿科焦虑问题的理想选择，具体是因为：1) 初级保健中过度焦虑的患病率很高（约 10-20%），2) 超过 90% 的焦虑症患者 青少年报告身体不适（例如胃痛）并且是初级保健机构的“常旅客”，3) 与未接受 PCP 治疗的儿童相比，患有疾病的儿童更有可能升高 焦虑，以及 4) PCP 通常是儿童第一个也是唯一一个就诊的健康专业人员。该提案建立在 PI 与 PCP 的开发和可行性试点工作是 NIMH 资助的精神中心的一部分 作为教育部拨款的一部分，儿科初级保健和学校护士的健康。这 AxAP 仿照 PCP 熟悉的哮喘行动计划，基于认知的核心要素 焦虑的行为疗法（即行为暴露）旨在适应短期初级保健就诊 （20-30 分钟），可以虚拟授课，时间简短（1-4 次会议），并且可以按办公室访问付费。 与托管或集成模型形成鲜明对比的是，AxAP 的独特之处在于增强 PCP 识别和干预焦虑青少年的能力，这将提高总体护理的可及性 尤其是在心理健康专家很少的地方。该提案还包含多项创新 功能包括对以下措施进行试点测试：1) AxAP 的成本效益分析，2) 在儿童、家长和 PCP 层面检查基于理论的目标机制。如果这项研究的结果是 积极的结果将支持使用可传播的干预措施进行大规模有效性试验 这可以显着改善对焦虑青少年的临床护理，增强 PCP 识别的能力 减少焦虑，并降低与儿科焦虑相关的个人和经济成本。