Harvard Medical School, Boston, Massachusetts.
Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts.
Prim Care Companion CNS Disord. 2022 Apr 19;24(2):21m03045. doi: 10.4088/PCC.21m03045.
ABSTRACT. Noncardiac chest pain is common and can cause distress, impair quality of life, and lead to recurrent evaluation. It is often multifactorial in etiology and influenced by psychological factors. The objective of this study was to describe the development, implementation, and preliminary feasibility of an 8-week multicomponent care management intervention. Participants with noncardiac chest pain were recruited from primary care clinics, ambulatory cardiac stress testing, and the emergency department (ED) at an urban academic hospital from March 2019 to November 2019. The care management team consisted of a nurse, cardiologist, and psychiatrist. Following a 1-time consultation visit with the cardiologist and nurse, evaluation and treatment recommendations were conveyed to the participant's primary care physician. The nurse completed 8 weekly phone calls with the participant to provide support, introduce therapeutic principles, and assist with care coordination under the supervision of a psychiatrist. Intervention feasibility was assessed on 7 domains. To examine preliminary efficacy, the number of ED visits was recorded, and participants completed pre-post measures of psychological health and health-related quality of life and Likert scales of chest pain symptom severity, frequency, and impact. The intervention was developed and implemented in 3 patients who completed 100% of the consultation visits and a mean of 95.8% of study phone calls. There were no adverse events or ED visits. Mean scores for chest pain severity, chest pain frequency, chest pain impact, depression, anxiety, and somatization all improved. No other trends were observed. The findings suggest that a care management intervention may be feasible with potential to improve chest pain symptoms and psychological outcomes. A larger, randomized trial is needed to explore the efficacy of this intervention. ClinicalTrials.gov identifier: NCT04904198.
摘要。非心源性胸痛很常见，可导致痛苦、降低生活质量并导致反复评估。其病因通常是多因素的，并受心理因素影响。本研究的目的是描述一个 8 周多组分的管理干预措施的开发、实施和初步可行性。非心源性胸痛患者于 2019 年 3 月至 11 月从初级保健诊所、门诊心脏应激测试和城市学术医院的急诊部招募。护理管理团队由护士、心脏病专家和精神科医生组成。在与心脏病专家和护士进行一次咨询访问后，将评估和治疗建议转达给患者的初级保健医生。护士在精神科医生的监督下，每周与患者进行 8 次电话随访，提供支持、介绍治疗原则并协助护理协调。通过 7 个领域评估干预措施的可行性。为了检查初步疗效，记录了急诊就诊次数，参与者完成了心理健康和健康相关生活质量的前后测量，以及胸痛症状严重程度、频率和影响的李克特量表。该干预措施在 3 名患者中进行了开发和实施，他们完成了 100%的咨询访问和平均 95.8%的研究电话访问。没有不良事件或急诊就诊。胸痛严重程度、胸痛频率、胸痛影响、抑郁、焦虑和躯体化的平均评分均有所改善。没有观察到其他趋势。研究结果表明，护理管理干预措施可能具有可行性，并有潜力改善胸痛症状和心理结局。需要进行更大规模的随机试验来探索该干预措施的疗效。ClinicalTrials.gov 标识符：NCT04904198。
