Increasing Reach of Evidence-Based Psychotherapies in CBOCs: Identifying Needs and Strategies for Scale Out

扩大基于证据的心理治疗在 CBOC 中的影响力：确定扩展的需求和策略

• 批准号: 9717703
• 负责人: Katherine M Iverson
• 金额: --
• 依托单位: VA BOSTON HEALTH CARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-10-01 至 2020-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9717703
• 关键词: Address; Administrator; Adoption; Ambulatory Care Facilities; Anxiety; Appointment; Attitude; Caring; Clinical; Communities; Consumption; Decision Making; Development; Diagnosis; Disease; Effectiveness; Enabling Factors; Evidence based practice; Goals; Health; Health Services Accessibility; Healthcare; Healthcare Systems; Hospitals; Improve Access; Intervention; Interview; Left; Location; Maintenance; Medical center; Mental Depression; Mental Health; Mental disorders; Outcome; Patients; Penetration; Policies; Positioning Attribute; Post-Traumatic Stress Disorders; Preparation; Provider; Psyche structure; Psychotherapy; Public Health; Recommendation; Research; Research Personnel; Resources; Rural; Rural Community; Rural Health; Suggestion; Suicide; Symptoms; System; Testing; Time; Training; Travel; Veterans; Work; base; clinical practice; clinically significant; community based practice; contextual factors; cost; effective therapy; evidence base; flexibility; high risk; implementation research; implementation science; implementation strategy; improved; negative affect; programs; reduce symptoms; research study; research to practice; rural setting; scale up; success; suicidal risk; symptomatic improvement; training opportunity; uptake; urban setting

Evidence-based psychotherapies (EBPs) have demonstrated effectiveness for numerous presenting problems including posttraumatic stress disorder, depression, and anxiety. Rates of these disorders are elevated in Veterans, creating a significant public health impact. Untreated mental health diagnoses increase risk of suicide, further elevating the need for effective treatments. Efforts to treat these mental health problems within the Department of Veterans Affairs (VA) have largely been addressed through national EBP rollouts. These EBP rollouts have been disseminated broadly, yet limited uptake has been demonstrated across VA settings, especially in Community Based Outpatient Clinics (CBOCs). Access to EBPs through CBOCs is crucial to increase timeliness and efficiency in mental healthcare as more than half of Veterans utilizing the VA system go to CBOCs for care. Moreover, Veterans presenting to rural CBOCs are receiving significantly less mental health appointments compared to urban CBOCs, highlighting a discrepancy in access to care by location. Although we know that rural Veterans are receiving less care, most of the research on EBP implementation has been done outside of the CBOC setting. Identifying what care Veterans in CBOCs are getting, why they may not be getting EBPs, and how to meet the needs of CBOC providers is vital to enhancing access to EBPs through tailored implementation strategies. Without this information, enhanced implementation of EBPs in CBOCs is unlikely and the access to mental health care problem will be perpetuated. To maximize the likelihood of broad EBP implementation in CBOCs, it is essential that implementation strategies are feasible and acceptable in CBOC contexts, which includes consideration for both rural and urban settings. EBP implementation in the VA system has traditionally been a top-down approach, which may ignore important contextual factors that impact successful implementation. Important factors that are often overlooked include, the potential need for adaptations to interventions and delivery to best fit context of care. Given that CBOCs differ significantly from main VA hospitals, understanding the impact of these factors is important. Important information about these contextual factors can be obtained through qualitative interview with CBOC providers in rural and urban settings. This project will maximize a unique opportunity to understand the potential fit of alternative approaches for EBP delivery in CBOCs to enhance reach and sustainment of EBPs. Research will be guided by evidence-based conceptual frameworks and will utilize a stakeholder advisory board to produce expert recommendations to enhance implementation strategies in rural and urban CBOCs. The research study will be conducted by a team of investigators with expertise in implementation science, qualitative analyses and EBPs within the VA systems. With input from operational partners, the resulting products have the potential to significantly improve timeliness and efficiency in EBP implementation in CBOCs across rural and urban settings. Over all, the proposed study will advance national efforts to maximize delivery of best clinical practices for CBOCs in rural and urban settings and will maximize efficiency and timeliness of mental health care for Veterans. Next steps for this project will be to disseminate findings through an IIR submission that will allow for testing of clinical recommendations and tailorable scale-up strategies for increasing access to, and use of, EBPs in rural and urban CBOCs.

循证心理治疗 (EBP) 已被证明对解决许多当前问题有效 包括创伤后应激障碍、抑郁和焦虑。这些疾病的发生率在 退伍军人，对公共卫生产生重大影响。未经治疗的心理健康诊断会增加以下风险 自杀，进一步增加了对有效治疗的需求。努力治疗这些心理健康问题 退伍军人事务部 (VA) 的问题主要通过全国 EBP 推广得到解决。这些 EBP 的推出已得到广泛传播，但在 VA 环境中的采用情况有限， 特别是在社区门诊诊所 (CBOC)。通过 CBOC 获取 EBP 至关重要 超过一半的退伍军人使用 VA 系统，提高了心理保健的及时性和效率 前往 CBOC 寻求护理。此外，在农村 CBOC 任职的退伍军人接受的心理治疗明显较少 与城市 CBOC 相比，医疗预约的情况突出了不同地点获得医疗服务的差异。 尽管我们知道农村退伍军人接受的护理较少，但大多数关于 EBP 实施的研究 已在 CBOC 环境之外完成。确定 CBOC 中的退伍军人正在获得哪些护理以及为何获得这些护理 可能无法获得 EBP，如何满足 CBOC 提供商的需求对于增强 EBP 的获取至关重要 通过量身定制的实施策略。如果没有这些信息，EBP 的实施将无法得到加强 CBOC 不太可能出现，获得精神卫生保健的问题将长期存在。为了最大化 CBOC 中广泛实施 EBP 的可能性，实施策略的可行性至关重要 并且在 CBOC 背景下可以接受，其中包括考虑农村和城市环境。电子血压计 VA系统的实施传统上是自上而下的方法，这可能会忽略重要的 影响成功实施的背景因素。经常被忽视的重要因素包括： 调整干预措施和提供最适合护理环境的潜在需要。鉴于 CBOC 与主要退伍军人管理局医院有很大不同，了解这些因素的影响很重要。重要的 有关这些背景因素的信息可以通过与 CBOC 提供商的定性访谈获得 在农村和城市环境中。该项目将最大限度地提供独特的机会来了解潜在的适合性 在 CBOC 中提供 EBP 的替代方法，以增强 EBP 的覆盖范围和维持。研究将 以基于证据的概念框架为指导，并将利用利益相关者咨询委员会来制定 专家建议加强农村和城市中央银行的实施战略。研究研究 将由具有实施科学、定性分析和 VA 系统内的 EBP。通过运营合作伙伴的投入，最终产品有潜力 显着提高城乡央行EBP实施的及时性和效率 设置。总而言之，拟议的研究将推动国家努力最大限度地提供最佳临床 CBOC 在农村和城市环境中的实践，将最大限度地提高心理健康的效率和及时性 关心退伍军人。该项目的后续步骤将是通过 IIR 提交来传播研究结果，该报告将 允许测试临床建议和可定制的扩大策略，以增加获得和 EBP 在农村和城市 CBOC 的使用。