焦虑障碍指南在专业精神卫生保健中的实施效果。

Effectiveness of the implementation of guidelines for anxiety disorders in specialized mental health care.

机构信息

HSK Group, Arnhem and Department of Psychiatry, VU University Medical Centre and GGZinGeest, Amsterdam, the Netherlands.

Department of Psychiatry, UMC St. Radboud and Pro Persona Overwaal, Nijmegen, the Netherlands.

出版信息

Acta Psychiatr Scand. 2015 Jul;132(1):69-80. doi: 10.1111/acps.12338. Epub 2014 Sep 22.

DOI:10.1111/acps.12338

PMID:25243567

Abstract

OBJECTIVE

To examine the effect of implementing anxiety disorders guidelines on guideline adherence and patient outcomes in specialized mental health care.

METHOD

A treatment setting in which guidelines were implemented (intervention condition) was compared with one in which guidelines were only disseminated (control condition).

RESULTS

Of 61.7% of 81 intervention-condition patients received treatment according to the guidelines vs. 40.6% of 69 control-condition patients (P = 0.01). At 1-year follow-up, intervention-condition patients showed a greater decrease in anxiety symptoms (d = 0.48, P < 0.05); higher percentages of response (52.6% vs. 33.8%; P = 0.025) and remission (33.3% vs.16.9%; P = 0.026); and a greater decrease in the rate of phobic avoidance (d = 0.34, P < 0.05). At 2-year follow-up, control-condition patients had experienced a longer period of treatment, which had eroded most of these differences, except for phobic avoidance.

CONCLUSION

Systematic guideline implementation results in earlier gains and shorter treatment times.

摘要

目的

考察在专业精神卫生保健中实施焦虑障碍指南对指南遵循情况和患者结局的影响。

方法

将实施指南的治疗环境（干预条件）与仅传播指南的环境（对照条件）进行比较。

结果

81 例干预条件患者中，61.7%的患者按指南接受治疗，而 69 例对照条件患者中，这一比例为 40.6%（P = 0.01）。在 1 年随访时，干预条件患者的焦虑症状改善更明显（d = 0.48，P < 0.05）；应答率（52.6%比 33.8%；P = 0.025）和缓解率（33.3%比 16.9%；P = 0.026）更高；并且恐怖回避的发生率下降更多（d = 0.34，P < 0.05）。在 2 年随访时，对照条件患者的治疗时间延长，除恐怖回避外，这些差异大多已消失。