改善儿科行为问题的护理和临床结局：初级保健中护士管理干预的随机试验。
Improving access to care and clinical outcome for pediatric behavioral problems: a randomized trial of a nurse-administered intervention in primary care.
机构信息
Western Psychiatric Institute and Clinic, University of Pittsburgh School of Medicine, Pittsburgh, PA 15213, USA.
出版信息
J Dev Behav Pediatr. 2010 Jun;31(5):393-404. doi: 10.1097/DBP.0b013e3181dff307.
OBJECTIVE
To determine the effectiveness of an on-site modular intervention in improving access to mental health services and outcomes for children with behavioral problems in primary care relative to enhanced usual care. The study includes boys and girls from six primary care offices in metropolitan Pittsburgh, PA.
METHODS
One hundred sixty-three clinically referred children who met a modest clinical cutoff (75th percentile) on the externalizing behavior scale of the Pediatric Symptom Checklist-17 were randomized to a protocol for on-site, nurse-administered intervention or to enhanced usual care. Protocol for on-site, nurse-administered intervention applied treatment modules from an evidence-based specialty mental health treatment for children with disruptive behavior disorders that were adapted for delivery in the primary care setting; enhanced usual care offered diagnostic assessment, recommendations, and facilitated referral to a specialty mental health provider in the community. The main outcome measures such as standardized rating scales, including the Pediatric Symptom Checklist-17, individualized target behavior ratings, treatment termination reports, and diagnostic interviews were collected.
RESULTS
Protocol for on-site, nurse-administered intervention cases were significantly more likely to receive and complete mental health services, reported fewer service barriers and more consumer satisfaction, and showed greater, albeit modest, improvements on just a few clinical outcomes that included remission for categorical behavioral disorders at 1-year follow-up. Both conditions also reported several significant improvements on several clinical outcomes over time.
CONCLUSIONS
A psychosocial intervention for behavior problems that was delivered by nurses in the primary care setting is feasible, improves access to mental health services, and has some clinical efficacy. Options for enhancing clinical outcome include the use of multifaceted collaborative care interventions in the pediatric practice.
目的
确定现场模块干预在改善儿童行为问题的初级保健中获得心理健康服务和结果的有效性，与增强的常规护理相比。该研究包括宾夕法尼亚州匹兹堡大都市的六个初级保健办公室的男孩和女孩。
方法
163 名临床转诊儿童在儿科症状清单 17 的外在行为量表上达到适度的临床截止值（第 75 个百分位），随机分配到现场、护士管理干预的方案或增强的常规护理。现场、护士管理干预方案应用了从基于证据的儿童破坏性行为障碍专业精神治疗中改编的治疗模块，以便在初级保健环境中提供；增强的常规护理提供了诊断评估、建议，并促进了向社区专业精神卫生提供者的转介。主要结果测量标准，包括儿科症状清单 17、个体化目标行为评分、治疗终止报告和诊断访谈。
结果
现场、护士管理干预方案的病例更有可能接受和完成心理健康服务，报告的服务障碍较少，消费者满意度较高，尽管只是一些临床结果显示出适度的改善，包括在 1 年随访时的分类行为障碍缓解。两种情况也报告了几个临床结果的几个显著改善。
结论
在初级保健环境中由护士提供的行为问题心理社会干预是可行的，改善了获得心理健康服务的机会，并具有一定的临床疗效。增强临床效果的选择包括在儿科实践中使用多方面的协作护理干预措施。
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