在初级保健中实施焦虑障碍患者临床实践指南的有效性：集群随机试验。

Effectiveness of a clinical practice guideline implementation strategy for patients with anxiety disorders in primary care: cluster randomized trial.

机构信息

Centro de Salud El Naranjo, Gerencia Atención Primaria, Servicio Madrileño de Salud, Spain.

出版信息

Implement Sci. 2011 Dec 1;6:123. doi: 10.1186/1748-5908-6-123.

DOI:10.1186/1748-5908-6-123

PMID:22132861

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3283530/

Abstract

BACKGROUND

Anxiety is a common mental health problem seen in primary care. However, its management in clinical practice varies greatly. Clinical practice guidelines (CPGs) have the potential to reduce variations and improve the care received by patients by promoting interventions of proven benefit. However, uptake and adherence to their recommendations can be low.

METHOD/DESIGN: This study involves a community based on cluster randomized trial in primary healthcare centres in the Madrid Region (Spain). The project aims to determine whether the use of implementation strategy (including training session, information, opinion leader, reminders, audit, and feed-back) of CPG for patients with anxiety disorders in primary care is more effective than usual diffusion. The number of patients required is 296 (148 in each arm), all older than 18 years and diagnosed with generalized anxiety disorder, panic disorder, and panic attacks by the Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV). They are chosen by consecutive sampling. The main outcome variable is the change in two or more points into Goldberg anxiety scale at six and twelve months. Secondary outcome variables include quality of life (EuroQol 5D), and degree of compliance with the CPG recommendations on treatment, information, and referrals to mental health services. Main effectiveness will be analyzed by comparing the patients percentage improvement on the Goldberg scale between the intervention group and the control group. Logistic regression with random effects will be used to adjust for prognostic factors. Confounding factors or factors that might alter the effect recorded will be taken into account in this analysis.

DISCUSSION

There is a need to identify effective implementation strategies for CPG for the management of anxiety disorders present in primary care. Ensuring the appropriate uptake of guideline recommendations can reduce clinical variation and improve the care patients receive.

TRIAL REGISTRATION

ISRCTN: ISRCTN83365316.

摘要

背景

焦虑是初级保健中常见的心理健康问题。然而，其在临床实践中的管理差异很大。临床实践指南（CPG）有可能通过促进已证明有益的干预措施来减少差异并改善患者所接受的护理。但是，其建议的采纳和遵守率可能很低。

方法/设计：本研究涉及马德里地区（西班牙）初级保健中心的基于社区的整群随机试验。该项目旨在确定在初级保健中使用焦虑障碍患者 CPG 的实施策略（包括培训课程、信息、意见领袖、提醒、审核和反馈）是否比常规传播更有效。需要的患者数量为 296 名（每组 148 名），均大于 18 岁，并且根据《精神障碍诊断与统计手册-IV》（DSM-IV）诊断为广泛性焦虑障碍、恐慌症和恐慌发作。他们通过连续抽样选择。主要结局变量是在六个月和十二个月时，Goldberg 焦虑量表的两个或更多点变化。次要结局变量包括生活质量（EuroQol 5D），以及治疗、信息和向心理健康服务转诊方面对 CPG 建议的依从程度。主要有效性将通过比较干预组和对照组患者在 Goldberg 量表上的改善百分比来分析。将使用具有随机效应的逻辑回归来调整预后因素。将考虑混杂因素或可能改变记录效果的因素来进行此分析。