Strategies to Improve PTSD Care

改善创伤后应激障碍 (PTSD) 护理的策略

• 批准号: 8731426
• 负责人: Nancy Bernardy
• 金额: --
• 依托单位: WHITE RIVER JUNCTION VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-01-01 至 2015-12-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8731426
• 关键词: Academic Detailing; Accounting; Address; Adherence; Benzodiazepines; Caring; Characteristics; Chronic; Clinical Practice Guideline; Cognitive Therapy; Data; Department of Defense; Development; Diagnosis; Educational Intervention; Effectiveness; Evaluation; Evidence based treatment; Family member; Feedback; Fostering; Goals; Guidelines; Individual; Intervention; Interview; Knowledge; Learning; Medical center; Mental Health; Methodology; Modeling; Modification; Outcome; Patient Preferences; Patients; Pattern; Perception; Pharmaceutical Preparations; Pharmacists; Pharmacotherapy; Post-Traumatic Stress Disorders; Provider; Psychotherapy; Recommendation; Recovery; Reporting; Research; Safety; Services; Solutions; Structure; Subgroup; Symptoms; Testing; Training Programs; Transcript; Veterans; Work; alternative treatment; design; evidence base; high risk; improved; intervention program; meetings; motivational enhancement therapy; outreach; programs; tool; treatment strategy

In this project we propose to conduct research that will allow us to examine the use of an academic detailing (AD) approach to share decision support tools with prescribing clinicians (providers) to decrease benzodiazepine prescribing in Veterans with PTSD. The AD approach supplements traditional AD outreach with facility-specific strategies that include development of solutions for local barriers. Our research group has conducted formative evaluation work that identified subgroups of Veterans with PTSD in which the prescribing of benzodiazepines has increased rates and the most potential for harm. It is possible the subgroups are also the ones who might have the most difficulty decreasing their benzodiazepine use, creating a burden on providers. Thus there is a need to focus educational efforts on these Veterans specifically that offer evidence- based options so they can make informed decisions for their care. We propose to address the following four specific research aims: Aim 1: Develop decision support tools and obtain input from providers and patients. Content for the decision support tools will initially be developed by a team of PTSD experts. Feedback from providers and patients will be obtained through individual qualitative interviews and incorporated at each step in the modification and development of final tools. The decision supports tools will provide general information about benzodiazepines; incorporate safety concerns related to the targeted subgroups, offer tapering guidance and information on safer, evidence-based treatments for PTSD. Aim 2: Use an enhanced academic detailing approach to beta test the decision support tools with providers. Using the VA Academic Detailing service in VISNs 21 & 22, we will obtain feedback on the effectiveness of the materials by providers and pharmacists assigned to work with the providers as detailers. Using data obtained through the VA Mental Health Dashboard we will identify providers with the highest caseload of Veterans with PTSD in the subgroups to participate in this research. The AD team will meet with the individual providers to review their caseload, review the decision support tools, and discuss motivational interviewing strategies to use with their patients, taking into account local context and needs. A facilitation checklist will be used to allow evaluation of the intervention and local adaptations needed. Aim 3: Conduct semi-structured interviews with providers and pharmacists to get their perspective on facilitators and barriers as to the use of the decision support tools with patients and the academic detailing program at their facility. To address this aim, we will conduct individual semi-structured qualitative interviews with the providers and pharmacists who participated in the Aim 2 intervention. Qualitative content analysis will be conducted on interview transcripts using previous methodology in our work. Aim 4: Collect limited facility and provider level quantitative outcomes that include changes in prescribing patterns and patient referrals to cognitive-behavioral therapy (CBT) from administrative data. To address this aim, we will use reports generated by the Mental Health Dashboard that will provide demographic data, changes in benzodiazepine prescribing patterns and other medication changes that might be reflected as "substitutes" for benzodiazepines. Referrals to PTSD evidence-based psychotherapy treatment will also be obtained by chart review.

在这个项目中，我们建议进行研究，以使我们能够研究学术细节的使用 （AD）与开处方临床医生（提供者）共享决策支持工具的方法以减少 用PTSD在退伍军人中处方的苯二氮卓类药物。广告方法补充了传统的广告外展 采用特定于设施的策略，包括开发当地障碍的解决方案。我们的研究小组有 进行了形成性评估工作，该工作确定了有PTSD的退伍军人亚组 苯二氮卓类药物的发生率提高和最大的伤害潜力。亚组也可能是 那些可能很难减少苯二氮卓的使用的人，从而造成了负担 提供者。因此，有必要将教育努力集中在这些退伍军人上，特别是提供证据 - 基于选择，以便他们可以做出明智的决定。我们建议解决以下四个 具体研究目的： 目标1：开发决策支持工具，并从提供者和患者那里获得意见。内容的内容 决策支持工具最初将由PTSD专家团队开发。提供者的反馈和 患者将通过个人定性访谈获得，并在每个步骤中纳入 最终工具的修改和开发。决策支持工具将提供有关的一般信息 苯二氮卓类；结合与目标子组有关的安全问题，提供逐渐的指导和 有关PTSD的更安全，基于证据的治疗的信息。 目标2：使用增强的学术细节方法来测试决策支持工具 提供者。使用VISNS 21和22中的VA学术细节服务，我们将获得有关 提供者和药剂师分配与提供者合作的材料的有效性 详细信息。使用通过VA心理健康仪表板获得的数据，我们将确定提供者 亚组中有PTSD的退伍军人的最高案件参加了这项研究。广告团队将 与各个提供商会面以审查其案件，审查决策支持工具，并讨论 考虑到当地的环境和需求，励志采访策略与患者使用。一个 促进清单将用于允许评估所需的干预措施和本地改编。 目标3：对提供者和药剂师进行半结构化访谈，以了解他们的观点 促进者和障碍，以与患者和学者一起使用决策支持工具 在其设施中详细介绍程序。为了解决这一目标，我们将进行单独的半结构定性 与参加AIM 2干预的提供者和药剂师的访谈。定性内容 分析将在我们的工作中使用以前的方法对成绩单进行。 目标4：收集有限的设施和提供商级别的定量结果，包括更改 行政管理的处方模式和患者转诊对认知行为疗法（CBT） 数据。为了解决这个目标，我们将使用心理健康仪表板生成的报告 人口统计数据，苯二氮卓类药物处方模式的变化以及其他可能的药物变化 被反映为苯二氮卓类药物的“替代品”。转介给PTSD基于证据的心理治疗 也将通过图表审查获得。