Abstract：
OBJECTIVE: To evaluate the effects of behavioral health interventions delivered within pediatric integrated primary care models on clinical outcomes.
METHODS: We searched Medline, EMBASE, CENTRAL, PsycINFO, and SCOPUS for studies published from January 1, 1998, to September 20, 2023. We included studies that evaluated onsite behavioral health integration in pediatric primary care using a comparator condition (usual, enhanced usual care, or waitlist). Outcome data on symptom change, impairment/quality of life, health indicator, and behavior change were extracted using Covidence software. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guideline was followed Risk of bias analysis was conducted using the Cochrane Risk of Bias tool. We used multilevel meta-analysis to synthesize multiple outcomes nested within studies. Open Science Foundation pre-registration: #10.17605/OSF.IO/WV7XP.
RESULTS: In total, 33 papers representing 27 studies involving 6,879 children and caregivers were included. Twenty-four studies were randomized controlled trials and three were quasi-experimental designs. Seventeen papers reported on treatment trials and 16 reported on prevention trials. We found a small overall effect size (SMD = 0.19, 95% confidence interval [0.11, 0.27]) supporting the superiority of integrated primary care to usual or enhanced usual care. Moderator analyses suggested similar effectiveness between co-located and integrated models and no statistically significant differences were found between treatment and prevention trials.
CONCLUSIONS: Results suggest that integrated primary care is superior to usual and enhanced usual care at improving behavior, quality of life, and symptoms. Integrated primary care research needs improved standards for reporting to promote better synthesis and understanding of the literature.
METHODS: We searched Medline, EMBASE, CENTRAL, PsycINFO, and SCOPUS for studies published from January 1, 1998, to September 20, 2023. We included studies that evaluated onsite behavioral health integration in pediatric primary care using a comparator condition (usual, enhanced usual care, or waitlist). Outcome data on symptom change, impairment/quality of life, health indicator, and behavior change were extracted using Covidence software. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guideline was followed Risk of bias analysis was conducted using the Cochrane Risk of Bias tool. We used multilevel meta-analysis to synthesize multiple outcomes nested within studies. Open Science Foundation pre-registration: #10.17605/OSF.IO/WV7XP.
RESULTS: In total, 33 papers representing 27 studies involving 6,879 children and caregivers were included. Twenty-four studies were randomized controlled trials and three were quasi-experimental designs. Seventeen papers reported on treatment trials and 16 reported on prevention trials. We found a small overall effect size (SMD = 0.19, 95% confidence interval [0.11, 0.27]) supporting the superiority of integrated primary care to usual or enhanced usual care. Moderator analyses suggested similar effectiveness between co-located and integrated models and no statistically significant differences were found between treatment and prevention trials.
CONCLUSIONS: Results suggest that integrated primary care is superior to usual and enhanced usual care at improving behavior, quality of life, and symptoms. Integrated primary care research needs improved standards for reporting to promote better synthesis and understanding of the literature.
摘要：
目的：评估在儿科综合初级保健模式中实施的行为健康干预措施对临床结局的影响。
方法：我们搜索了Medline，EMBASE,中部,PsycINFO,和SCOPUS为1998年1月1日至2023年9月20日发表的研究。我们纳入了使用比较条件（通常，加强日常护理，或等待名单)。症状变化的结果数据，损害/生活质量，健康指标,使用Covidence软件提取行为变化。遵循系统评价和荟萃分析（PRISMA）指南的首选报告项目使用Cochrane偏差风险工具进行偏差风险分析。我们使用多水平荟萃分析来综合研究中嵌套的多个结果。开放科学基金会预注册：#10.17605/OSF。IO/WV7XP。
结果：总计，包括33篇论文，代表27项研究，涉及6,879名儿童和护理人员。24项研究为随机对照试验，3项为准实验设计。17篇论文报道了治疗试验，16篇报道了预防试验。我们发现总体效果较小（SMD=0.19，95％置信区间[0.11，0.27]），支持综合初级保健优于常规或增强常规护理。主持人分析表明，在共同定位和整合模型之间具有相似的有效性，并且在治疗和预防试验之间没有发现统计学上的显着差异。
结论：结果表明，综合初级保健在改善行为方面优于常规护理和强化常规护理，生活质量,和症状。综合初级保健研究需要改进报告标准，以促进对文献的更好综合和理解。
方法：我们搜索了Medline，EMBASE,中部,PsycINFO,和SCOPUS为1998年1月1日至2023年9月20日发表的研究。我们纳入了使用比较条件（通常，加强日常护理，或等待名单)。症状变化的结果数据，损害/生活质量，健康指标,使用Covidence软件提取行为变化。遵循系统评价和荟萃分析（PRISMA）指南的首选报告项目使用Cochrane偏差风险工具进行偏差风险分析。我们使用多水平荟萃分析来综合研究中嵌套的多个结果。开放科学基金会预注册：#10.17605/OSF。IO/WV7XP。
结果：总计，包括33篇论文，代表27项研究，涉及6,879名儿童和护理人员。24项研究为随机对照试验，3项为准实验设计。17篇论文报道了治疗试验，16篇报道了预防试验。我们发现总体效果较小（SMD=0.19，95％置信区间[0.11，0.27]），支持综合初级保健优于常规或增强常规护理。主持人分析表明，在共同定位和整合模型之间具有相似的有效性，并且在治疗和预防试验之间没有发现统计学上的显着差异。
结论：结果表明，综合初级保健在改善行为方面优于常规护理和强化常规护理，生活质量,和症状。综合初级保健研究需要改进报告标准，以促进对文献的更好综合和理解。
