IMPROVING CARE FOR PANIC DISORDER IN PRIMARY CARE

随着管理式护理的兴起，初级保健环境作为检测和治疗所有精神健康问题的场所越来越重要。 在这种情况下，恐慌症是普遍存在的，认识不足，治疗不足。 因为它是致残的，而且经常伪装成各种其他医疗条件，它增加了直接（医生访问和不必要的测试）和间接（残疾日）成本。 这是一个多机构合作研究项目，旨在实施干预措施，以确定和治疗恐慌症的初级保健环境，并研究其临床和成本效益超过一年的时间。 三个研究中心（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查和识别患有恐慌症的患者，并测试在这种环境下为恐慌症提供服务的创新模式。 患者将随机接受初级保健医生的常规护理或协作护理（CC）。 CC采用认知行为心理治疗（由行为健康专家[BHS]在八周内提供六次会议），专家药物治疗（由BHS向处方初级保健医生转达的精神科医生的建议指导）和疾病管理元素（教育和激活患者和提供者，并通过电话联系在明年进行更仔细的监测和持续随访）。假设CC将具有上级临床有效性（在症状减轻、生活质量和功能方面进行测量）。 它还假设，虽然直接的医疗保健成本将高于CC比通常的护理，间接成本将较低，成本效益分析将支持通过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.