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

• Published in: BMC psychiatry Vol. 22; no. 1; p. 795
• Main Authors: Sung, Sharon C, Lim, Leslie, Lim, Swee Han, Finkelstein, Eric A, Chin, Steven Lim Hoon, Annathurai, Annitha, Chakraborty, Bibhas, Strauman, Timothy J, Pollack, Mark H, Ong, Marcus Eng Hock
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 16.12.2022; BioMed Central; BMC
• Subjects: Antidepressants; Anxiety; Anxiety - therapy; Anxiety Disorders - therapy; Care and treatment; Chest pain; Clinical outcomes; Clinical trials; Comorbidity; Cost analysis; Diagnosis; Drug therapy; Emergency department; Emergency medical care; Emergency service; Emergency Service, Hospital; Health care; Health surveys; Hospitals; Humans; Intervention; Multicenter Studies as Topic; Pain; Panic attack; Panic attacks; Panic disorder; Panic Disorder - diagnosis; Panic Disorder - therapy; Panic disorders; Panic-related anxiety; Patient-centered care; Patients; Primary care; Psychiatry; Quality of Life; Randomized Controlled Trials as Topic; Risk factors; Stepped-care model; Treatment Outcome; Singapore; Emergency department; Panic-related anxiety; Stepped-care model; Chest pain; Panic attack; Panic disorder; Cognitive behavioural therapy; Randomized controlled trial
• ISSN: 1471-244X; 1471-244X
• DOI: 10.1186/s12888-022-04387-z

Approximately 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. This 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. This 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. ClinicalTrials.gov NCT03632356. Retrospectively registered 15 August 2018.