Hassink-Franke Lieke J A, van Weel-Baumgarten Evelyn M, Wierda Eric, Engelen Maike Wm, Beek Mechtild M l, Bor Hans H J, van den Hoogen Henk J M, Lucassen Peter L B J, van Weel Chris
Department of Primary and Community Care, Radboud University Nijmegen Medical Centre, P.O. Box 9101, 6500 HB Nijmegen, The Netherlands.
J Prim Health Care. 2011 Sep 1;3(3):181-9.
In general practice many patients present with emotional symptoms. Both patients and physicians desire effective non-pharmacological treatments.
To study the effectiveness of problem-solving treatment (PST) delivered by trained general practice registrars (GP registrars) for patients with emotional symptoms.
In a controlled clinical trial we compared the effectiveness of PST versus usual care for patients with emotional symptoms. Dutch GP registrars provided either PST or usual care, according to their own preference. Patients were included if they (a) had presented for three or more consultations with emotional symptoms in the past six months; and (b) scored four or more on the 12-item General Health Questionnaire. Outcomes at three- and nine-month follow-up were standard measures of depression, anxiety and quality of life.
Thirty-eight GP registrars provided PST and included 98 patients; 43 provided usual care and included 104 patients. PST patients improved significantly more than usual care patients: at nine-month follow-up, recovery rates for somatoform disorder and anxiety were higher in the PST group (OR 6.50, p=0.01 respectively OR 11.25, p=0.03). PST patients had improved significantly more on the domains social functioning, role limitation due to emotional problems and general health perception.
Patients with emotional symptoms improved significantly more after PST delivered by motivated GP registrars than after usual care by GP registrars. Further research, with randomisation of interested registrars or interested GPs, is needed.
在全科医疗中，许多患者表现出情绪症状。患者和医生都希望获得有效的非药物治疗方法。
研究由经过培训的全科实习医生（GP实习生）提供的问题解决疗法（PST）对有情绪症状患者的有效性。
在一项对照临床试验中，我们比较了PST与常规护理对有情绪症状患者的有效性。荷兰的GP实习生根据自己的偏好提供PST或常规护理。纳入的患者需满足以下条件：（a）在过去六个月内因情绪症状进行过三次或以上的会诊；（b）在12项一般健康问卷上的得分达到4分或以上。在三个月和九个月随访时的结果是抑郁、焦虑和生活质量的标准测量指标。
38名GP实习生提供了PST，纳入了98名患者；43名提供了常规护理，纳入了104名患者。接受PST的患者比接受常规护理的患者改善更为显著：在九个月随访时，PST组中躯体形式障碍和焦虑的康复率更高（OR分别为6.50，p = 0.01；OR为11.25，p = 0.03）。PST组患者在社会功能、因情绪问题导致的角色限制和总体健康感知等方面的改善也更为显著。
有情绪症状的患者在由积极的GP实习生提供PST后，比由GP实习生提供常规护理后的改善更为显著。需要进行进一步的研究，将感兴趣的实习生或感兴趣的全科医生进行随机分组。
