A pragmatic trial of brief CBT for anxiety in VA primary care

退伍军人事务部初级保健中短暂 CBT 治疗焦虑的实用试验

• 批准号: 10844344
• 负责人: Jeffrey Alexander Cully
• 金额: --
• 依托单位: MICHAEL E DEBAKEY VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-10-01 至 2024-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10844344
• 关键词: Address; Adoption; Anxiety; Anxiety Disorders; Attention; Brief Psychotherapy; Caring; Clinic; Clinical; Clinical Practice Guideline; Clinical effectiveness; Cognitive Therapy; Data; Diagnosis; Disease; E-learning; Effectiveness; Eligibility Determination; Evidence based intervention; Evidence based treatment; Future; Goals; Health Sciences; Health Services; Health Services Accessibility; Healthcare; Home; Homogeneously Staining Region; Improve Access; Individual; Intervention; Interview; Leadership; Learning; Measurement; Medical; Medical Records; Mental Depression; Mental Health; Mental Health Services; Methods; Outcome; Panic; Participant; Patient Education; Patient Preferences; Persons; Post-Traumatic Stress Disorders; Pragmatic clinical trial; Prediction of Response to Therapy; Primary Care; Provider; Psychotherapy; Quality of Care; Quality of life; Randomized; Reach, Effectiveness, Adoption, Implementation, and Maintenance; SF-12; Services; Site; Social Phobia; Standardization; Suicide; Surveys; Technology; Therapeutic Intervention; Time; Training; Training Programs; Veterans; Veterans Health Administration; Work; anxiety reduction; anxiety symptoms; anxiety treatment; attentional control; care delivery; care preference; care seeking; care systems; design; effectiveness evaluation; evidence base; flexibility; formative assessment; functional disability; generalized anxiety; health related quality of life; health service use; implementation outcomes; implementation science; improved; innovation; integrated care; medical specialties; multi-site trial; practice setting; pragmatic randomized trial; pragmatic trial; primary care patient; primary care setting; programs; psychiatric comorbidity; recruit; reduce symptoms; service delivery; skills; success; telehealth; treatment as usual; treatment response; trial design

Anticipated Impacts on Veteran's Healthcare VA has established strategic goals related to “Access” and "Timely and Integrated Care". The proposed pragmatic trial targets these goals by addressing a significant gap in VA mental health care - namely the treatment of anxiety in the primary care setting using innovative delivery options. Using a partnership approach, the project will examine the effectiveness and implementation potential of a brief psychotherapy program for Veterans with anxiety in primary care. Psychotherapy services will be delivered either in-person or through VA Video Connect-Home (VVC-H). Clinical and implementation outcomes will inform future dissemination efforts to improve access and delivery of high quality anxiety care in VA primary care settings. Background Anxiety disorders are common in VA primary care settings and are associated with substantial functional impairment, poor health-related quality of life, suicide, and high rates of comorbid psychiatric and medical disorders. No brief psychotherapy interventions for anxiety currently exist for VA primary care settings - where many Veterans seek care. Cognitive Behavioral Therapy (CBT) is a first line treatment for anxiety but Primary Care Mental Health Integration (PCMHI) providers need an intervention approach for anxiety disorders that is brief, problem-focused, and fits into their system of care. Objectives The proposed 4-year, multisite trial will use a pragmatic randomized trial design to examine the effectiveness and implementation potential of a brief CBT intervention for anxiety delivered either in-person or via VVC-H, according to patient preference. CBT will be delivered by existing PCMHI providers at three large VAMCs. Aim 1 will examine the clinical effectiveness of the bCBT intervention vs. EUC for anxiety and quality of life at 4-, 8-, and 12-month follow-ups. Aim 2 will determine factors associated with bCBT response and explore Veteran demographic and clinical factors associated with VVC-H engagement. An exploratory aim will use mixed, qualitative and quantitative methods to better understand implementation successes and challenges related to delivery and impact of bCBT anxiety and VVC-H use in the PCMHI setting. Methods The proposed project seeks to embed bCBT into PCMHI programs using existing VHA providers. A total of 225 Veterans diagnosed with an anxiety disorder will be recruited from three VAMCs. Eligible Veteran participants will be randomized to a bCBT or to an Enhanced Usual Care (EUC) condition. A professionally diverse set of PCMHI providers will be invited to deliver bCBT. Providers will receive bCBT training and support to embed treatment into their existing practice setting. Veterans randomized to bCBT will receive 4 – 9 sessions based upon treatment response (50% reduction in GAD-7) by session 4. Veterans will also be offered the choice of receiving bCBT in-person or through VVC-H. EUC participants will receive 4 brief monthly check- in calls from study staff and a note placed in their medical record alerting their provider to the presence of significant anxiety symptoms. BCBT treatment and EUC check-in calls will end at 4 months. Next Steps The proposed project leverages VA stakeholders at all levels to improve alignment of the work with VA and Veteran initiatives. Clinical outcomes will provide justifications or cautions to inform future evidence- based psychotherapy (EBP) programs. If positive, data will be used to assist VA leadership in the expansion of EBPs and VVC-H in PCMHI. For example, should the project produce robust clinical outcomes - next steps would involve a non-research / demonstration project in one or two VISNs where the project team will train and support a wider group of providers in the delivery of brief CBT for anxiety. The project team will use the web- based training program and clinical intervention materials as well as lessons learned from the proposed HSR&D IIR to support and enhance brief CBT delivery in a non-research context.

对退伍军人医疗保健VA的预期影响已经建立了与“访问”和 “及时和综合护理”。拟议的务实试验通过解决重大差距来针对这些目标 在VA心理保健中 - 即使用创新交付的初级保健设置中的动画处理 选项。使用合伙方法，该项目将检查有效性和实施潜力 在初级保健中有焦虑的退伍军人的简短心理治疗计划。心理治疗服务将是 通过面对面或通过VA视频连接家庭（VVC-H）交付。临床和实施结果 将为未来的传播努力，以改善VA中的高质量焦虑护理的访问和交付 初级保健设置。 背景焦虑症在VA初级保健环境中很常见，并且与大量相关 功能障碍，与健康相关的生活质量差，自杀以及合并症的高率 医疗疾病。目前，VA初级保健环境目前没有简短的心理治疗干预措施 - 许多退伍军人寻求照顾的地方。认知行为疗法（CBT）是焦虑的第一线治疗 初级保健心理健康整合（PCMHI）提供者需要一种干预方法来解决焦虑症 这是简短的，以问题为中心的，并且适合他们的护理系统。 目标拟议的4年，多站点试验将使用务实的随机试验设计来检查 短暂的CBT干预对焦虑的有效性和实施潜力是面对面的或 通过VVC-H，根据患者偏好。 CBT将由现有的PCMHI提供商在三个大型 VAMCS。 AIM 1将检查BCBT干预与EUC的临床有效性 在4个，8个月和12个月的随访中的生活。 AIM 2将确定与BCBT响应相关的因素和 探索与VVC-H参与度相关的资深人口和临床因素。探索性目标 使用混合，定性和定量方法更好地了解实施成功，并 与BCBT焦虑和VVC-H在PCMHI环境中使用的交付和影响有关的挑战。 方法拟议的项目试图使用现有的VHA提供商将BCBT嵌入PCMHI程序中。一个 总共将从三个VAMC中招募225名被诊断患有焦虑症的退伍军人。合格的老兵 参与者将被随机分为BCBT或增强的常规护理（EUC）条件。专业 将邀请各种PCMHI提供商提供BCBT。提供者将接受BCBT培训，并 支持将治疗嵌入其现有练习环境中。随机分配给BCBT的退伍军人将获得4 - 9 基于治疗反应（GAD-7降低50％）的会议。还将提供退伍军人 选择接受BCBT面对面或通过VVC-H的选择。 EUC参与者将获得4个简短的每月支票 - 在学习人员的电话和病历中的注释中，提醒他们的提供者的存在 重要的动画符号。 BCBT治疗和EUC入住通话将在4个月结束。 下一步拟议的项目利用VA利益相关者在各个层面上，以改善工作的一致性 VA和资深倡议。临床结果将提供理由或警告以告知未来证据 - 基于心理治疗（EBP）计划。如果积极，数据将用于协助VA领导 PCMHI中的EBP和VVC-H。例如，该项目应产生强大的临床结果 - 下一步 将在一个或两个Visn中涉及一个非研究 /示范项目，项目团队将训练和 支持更广泛的提供商来提供简短的CBT进行动画。项目团队将使用网络 基于培训计划和临床干预材料以及从建议的经验教训 在非研究环境中支持和增强简短的CBT交付的HSR＆D IIR。