Adapting Treatment Delivery to Improve Retention in Evidence-Based PTSD Treatment

调整治疗方式以提高循证 PTSD 治疗的保留率

• 批准号: 10539602
• 负责人: Stephanie Wells
• 金额: --
• 依托单位: DURHAM VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2023
• 资助国家: 美国
• 起止时间: 2023-01-01 至 2027-12-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10539602
• 关键词: Address; Administrator; Adoption; Caring; Clinic; Clinical; Clinical Trials Design; Cognitive; Competence; Consolidated Framework for Implementation Research; Data; Development; Distress; Dose; Dropout; Drops; Effectiveness; Evaluation; Feedback; Frequencies; Future; Hybrids; Intervention; Interview; Letters; Mental Depression; Mentors; Methodology; Methods; Modification; Outcome; Outpatients; Patient-Centered Care; Patients; Post-Traumatic Stress Disorders; Provider; Psychotherapy; Quality of life; Reporting; Research; Research Design; Resource Allocation; Resources; Schedule; Signal Transduction; Structure; Symptoms; System; Testing; Time; Training; Trauma; Uncontrolled Study; Veterans; Veterans Health Administration; Work; acceptability and feasibility; cohort; comparison group; data warehouse; design; effectiveness/implementation trial; evidence base; experience; health care service utilization; implementation facilitators; implementation science; improved; innovation; medical specialties; pilot trial; preference; premature; programs; randomized, clinical trials; reduce symptoms; satisfaction; social cognitive theory; systematic review; tau Proteins; treatment as usual; treatment comparison; treatment optimization; treatment program; treatment response

Background: Effective evidence-based psychotherapies (EBPs) for posttraumatic stress disorder (PTSD), such as Cognitive Processing Therapy (CPT) and Prolonged Exposure (PE) therapy, have competency- based trainings in place and are mandated to be available to Veterans with PTSD in the Veterans Health Administration (VHA). Despite their effectiveness, at least a third of Veterans will prematurely drop out of PTSD EBPs, which is associated with poorer clinical outcomes and greater healthcare utilization. Delivery of PTSD EBPs in a massed format of three or more sessions weekly have demonstrated promise for increasing treatment retention. It is hypothesized that massed EBPs will be feasible. Significance/Impact: The current proposal is highly significant: 1) PTSD EBP retention remains low, 2) prior research aimed to improve retention in PTSD EBPs has yielded only modest improvements, 3) research on massed treatments for PTSD outside of VHA suggest improved retention, but is limited by observational design and lack of comparison groups, and 4) PTSD is a high priority HSR&D domain. Innovation: This CDA-2 application is innovative: 1) it adapts PTSD EBP delivery by increasing the frequency of delivery, 2) the proposed feasibility randomized clinical trial (RCT) will inform a subsequent IIR to conduct the first RCT of massed PTSD EBPs in VHA, 3) the first study to examine multiple stakeholders' preferences, and perceived barriers and facilitators of massed PTSD EBPs, and 4) massed PTSD EBPs may improve PTSD treatment engagement and improve clinical outcomes. Specific Aims: Aim 1. Qualitatively explore through semi-structured interviews with stakeholders' (Veterans [n=16], providers [n=12], and administrators [n=12]) perceived barriers and facilitators to implementation, and preferences for massed PTSD treatment delivery within VHA PTSD specialty clinics to inform the development of the massed PTSD treatment program to be piloted in Aim 2. Aim 2a. Conduct a pilot pragmatic randomized clinical trial (RCT; n=30) to examine the feasibility and acceptability of massed EBP PTSD treatments (EBP-massed) compared to PTSD EBPs as they are typically delivered (EBP-TAU) in a VA PTSD Specialty Clinic. In addition, we will gather preliminary data on satisfaction, completion rates, session attendance, and PTSD, depression, and functioning outcomes. Aim 2b. Conduct a summative evaluation via qualitative interviews with all Veterans in the pilot trial (n=30) and with providers (n=4) who delivered massed treatment to contextualize the quantitative findings and further refine massed PTSD treatments for a future IIR. Aim 3a. Characterize a national cohort of Veterans who begin 1) massed PTSD EBPs and 2) PTSD EBPs TAU. Aim 3b. Among Veterans who initiated treatment, compare treatment completion (i.e., 8 sessions) rates between those who received massed EBPs and those who received EBP-TAU. Next Steps/Implementation: In Aim 1, we will conduct semi-structured qualitative interviews with Veterans (n=16), providers (n=12), and administrators (n=12). Social Cognitive Theory and the Consolidated Framework for Implementation Research will inform these interviews and results will inform our pilot trial in Aim 2a. In Aim 2a, we will conduct a feasibility RCT to compare massed PTSD EBPs to PTSD EBPs delivered as usual in a VA PTSD Specialty Clinic. In Aim 2b, we will utilize semi- structured qualitative interviews with Veterans and providers in the pilot trial to evaluate satisfaction and identify additional modifications to the massed treatment program. Aim 3a and 3b will utilize the VA's CDW.

背景：针对创伤后应激障碍（PTSD）的有效循证心理治疗（EBP）， 例如认知处理疗法（CPT）和延长暴露（PE）疗法，具有能力- 基础培训到位，并强制向退伍军人健康中心患有创伤后应激障碍 (PTSD) 的退伍军人提供培训 管理（VHA）。尽管效果显着，但至少有三分之一的退伍军人会过早退出 PTSD EBP，这与较差的临床结果和较高的医疗保健利用率相关。 以每周 3 次或更多疗程的集中形式提供 PTSD EBP 已被证明是有希望的 以提高治疗保留率。假设集中 EBP 是可行的。 意义/影响：当前提案非常重要：1) PTSD EBP 保留率仍然很低，2) 先前旨在提高 PTSD EBP 记忆力的研究仅取得了适度的改善，3) 对 VHA 之外的 PTSD 集中治疗的研究表明，保留率有所提高，但受到以下因素的限制： 观察设计和缺乏比较组，4) PTSD 是一个高度优先的 HSR&D 领域。 创新：该 CDA-2 应用程序具有创新性：1) 它通过增加 交付频率，2）拟议的可行性随机临床试验（RCT）将告知后续 IIR 将在 VHA 中对大量 PTSD EBP 进行首次随机对照试验，3) 第一项检查多个 利益相关者的偏好，以及集体 PTSD EBP 的感知障碍和促进因素，以及 4) 集体 PTSD EBP 可以提高 PTSD 治疗参与度并改善临床结果。 具体目标： 目标 1. 通过与利益相关者的半结构化访谈进行定性探索 （退伍军人 [n=16]、提供者 [n=12] 和管理人员 [n=12]）感知到的障碍和促进因素 VHA PTSD 专科诊所内集中 PTSD 治疗的实施和偏好 为目标 2 中试点的大规模 PTSD 治疗计划的制定提供信息。 目标 2a。进行试点实用随机临床试验（RCT；n=30）以检验可行性和 与 PTSD EBP 相比，集中 EBP PTSD 治疗（EBP-massed）的可接受性，因为它们通常是 在 VA PTSD 专业诊所交付 (EBP-TAU)。此外，我们还将收集初步数据 满意度、完成率、会议出席率、创伤后应激障碍、抑郁症和功能结果。 目标 2b。通过对试点试验中的所有退伍军人进行定性访谈进行总结性评估 (n=30) 并与提供集中治疗的提供者 (n=4) 进行定量治疗 发现并进一步完善针对未来 IIR 的集中 PTSD 治疗。 目标 3a。描绘全国退伍军人队列的特征，他们开始 1) 集中的 PTSD EBP 和 2) PTSD EBP TAU。 目标 3b。在开始治疗的退伍军人中，比较治疗完成率（即 8 次疗程） 接受集中 EBP 的人和接受 EBP-TAU 的人之间的差异。 后续步骤/实施：在目标 1 中，我们将进行半结构化定性访谈 退伍军人 (n=16)、提供者 (n=12) 和管理员 (n=12)。社会认知理论与 实施研究综合框架将为这些访谈提供信息，结果将 告知我们目标 2a 中的试点试验。在目标 2a 中，我们将进行可行性随机对照试验来比较集中的 PTSD EBP 至 PTSD EBP 在 VA PTSD 专业诊所照常提供。在目标 2b 中，我们将利用半 在试点试验中对退伍军人和提供者进行结构化定性访谈，以评估满意度 并确定对集中治疗计划的其他修改。目标 3a 和 3b 将利用 VA 的 CDW。