Protocol for a multi-site randomized controlled trial of a stepped-care intervention for emergency department patients with panic-related anxiety

BMC Psychiatry

Study Protocol

Steven Lim Hoon Chin¹  Timothy J. Strauman²  Sharon C. Sung³  Eric A. Finkelstein³  Bibhas Chakraborty⁴  Marcus Eng Hock Ong⁵  Mark H. Pollack⁶  Annitha Annathurai⁷  Swee Han Lim⁸  Leslie Lim⁸ 

[1] Changi General Hospital, 2 Simei Street 3, 529889, Singapore, Singapore;Duke University Medical Center, 10 Duke Medicine Cir, 27710, Durham, NC, USA;Duke-NUS Medical School Singapore, 8 College Road, 169857, Singapore, Singapore;Duke-NUS Medical School Singapore, 8 College Road, 169857, Singapore, Singapore;National University of Singapore, 6 Science Drive 2, 117546, Singapore, Singapore;Duke University, 2424 Erwin Road, Suite 1102, 27710, Durham, NC, USA;Duke-NUS Medical School Singapore, 8 College Road, 169857, Singapore, Singapore;Singapore General Hospital, Outram Road, 169608, Singapore, Singapore;Rush University Medical Center, 1645 W. Jackson Blvd, Suite 400, 60612, Chicago, IL, USA;Sage Therapeutics, 215 First Street, 02142, Cambridge, MA, USA;Sengkang General Hospital, 110 Sengkang E Way, 544886, Singapore, Singapore;Singapore General Hospital, Outram Road, 169608, Singapore, Singapore;

关键词: Panic-related anxiety;    Emergency department;    Panic attack;    Panic disorder;    Chest pain;    Stepped-care model;    Cognitive behavioural therapy;    Randomized controlled trial;   

DOI  :  10.1186/s12888-022-04387-z

 received in 2022-09-14, accepted in 2022-11-11,  发布年份 2022

来源: Springer

【 摘 要 】

BackgroundApproximately 40% of Emergency Department (ED) patients with chest pain meet diagnostic criteria for panic-related anxiety, but only 1–2% are correctly diagnosed and appropriately managed in the ED. A stepped-care model, which focuses on providing evidence-based interventions in a resource-efficient manner, is the state-of-the art for treating panic disorder patients in medical settings such as primary care. Stepped-care has yet to be tested in the ED setting, which is the first point of contact with the healthcare system for most patients with panic symptoms.MethodsThis multi-site randomized controlled trial (RCT) aims to evaluate the clinical, patient-centred, and economic effectiveness of a stepped-care intervention in a sample of 212 patients with panic-related anxiety presenting to the ED of Singapore’s largest public healthcare group. Participants will be randomly assigned to either: 1) an enhanced care arm consisting of a stepped-care intervention for panic-related anxiety; or 2) a control arm consisting of screening for panic attacks and panic disorder. Screening will be followed by baseline assessments and blocked randomization in a 1:1 ratio. Masked follow-up assessments will be conducted at 1, 3, 6, and 12 months. Clinical outcomes will be panic symptom severity and rates of panic disorder. Patient-centred outcomes will be health-related quality of life, daily functioning, psychiatric comorbidity, and health services utilization. Economic effectiveness outcomes will be the incremental cost-effectiveness ratio of the stepped-care intervention relative to screening alone.DiscussionThis trial will examine the impact of early intervention for patients with panic-related anxiety in the ED setting. The results will be used to propose a clinically-meaningful and cost-effective model of care for ED patients with panic-related anxiety.Trial registrationClinicalTrials.gov NCT03632356. Retrospectively registered 15 August 2018.

【 授权许可】

CC BY   
© The Author(s) 2022

【 图 表 】

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