科研之友
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摘要
BackgroundNon-cardiac chest pain (NCCP) affects up to 80% of patients attending chest pain clinics, but its treatment is suboptimal. AimTo describe the outcomes of a pilot, stepped care, biopsychosocial management programme in terms of improvements in chest pain, psychosocial scores and use of healthcare resources. MethodsOf 198 referrals, 77 patients were suitable for the clinic and received a one hour biopsychosocial assessment. Stepped care consisted of assessment only, low intensity Cognitive Behaviour Therapy (CBT), or high intensity CBT. ResultsThe proportion with pain occurring more than once monthly fell from 100% at baseline to 61% at 3months (p<0.001). Pain interference reduced significantly (p<0.001) from 5.9 [SD 2.2] at baseline to 3.2 [SD 2.6] at 3months. Depression scores improved from a mean 8.8 to 5.4 (p<0.05) and anxiety from 6.9 to 4.6 (p<0.05). Use of healthcare resources improved with a fall in consultations for chest pain over 6months from a mean 2.6 to 0.1 (p<0.05). The impact on work and social functioning reduced from 10.4 [SD 10.4] to 3.9 [SD 7.5]: [t (70)=6.3, p<0.001). Further improvements occurred at 6months for chest pain frequency (which fell to 51%, p=0.003), interference (2.6 [SD 2.1], p<0.05) and avoidance of exercise (p=0.03). Otherwise improvements were maintained between 3 and 6months. ConclusionA stepped-care biopsychosocial approach to NCCP is effective in reducing chest pain frequency and improving behaviour and wellbeing. It can be delivered in part by a nurse allowing integration into any chest pain clinic.
- 出版日期2015-9
