Reducing COVID-related PTSD symptoms in Frontline Healthcare Workers through Trauma-Focused Treatment in Employee Assistance Programs

通过员工援助计划中的创伤重点治疗，减少一线医护人员与新冠肺炎相关的创伤后应激障碍 (PTSD) 症状

• 批准号: 10689653
• 负责人: Rebecca Kaufman Sripada
• 金额: $ 74.07万
• 依托单位: UNIVERSITY OF MICHIGAN AT ANN ARBOR
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-09-01 至 2026-06-30
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10689653
• 关键词: Absenteeism; Address; Adherence; Aftercare; Age; Area; COVID-19; COVID-19 pandemic; COVID-19 treatment; Caring; Cognition; Community Practice; Consolidated Framework for Implementation Research; Cost Effectiveness Analysis; Data; Distress; Effectiveness; Effectiveness of Interventions; Employee; Employee Assistance Program (Health Care); Ensure; Ethnic Origin; Evidence based treatment; Future; Goals; Health; Health Personnel; Health Resources; Healthcare Systems; Hybrids; Infrastructure; Intervention; Interview; Lead; Maps; Measures; Mediating; Mediator; Mental Health; Michigan; Military Personnel; Mission; Modeling; National Institute of Mental Health; Occupations; Patients; Performance at work; Population; Post-Traumatic Stress Disorders; Primary Care; Procedures; Process; Professional counselor; Public Health; Quality of life; Quality-Adjusted Life Years; Race; Readiness; Resources; Severities; Stress; Structure; Symptoms; Testing; Therapeutic Effect; Time; Training; Trauma; Veterans Health Administration; Vulnerable Populations; active duty; adverse outcome; anxious; brief intervention; burnout; clinical practice; clinically significant; community setting; compare effectiveness; coronavirus disease; cost effective; cost effectiveness; current pandemic; design; disability; effective intervention; effectiveness evaluation; effectiveness research; effectiveness testing; effectiveness/implementation study; effectiveness/implementation trial; experience; functional improvement; future implementation; health care service organization; implementation barriers; implementation efforts; implementation facilitators; implementation strategy; improved; innovation; medical specialties; military service; pandemic disease; point of care; practice setting; process evaluation; programs; public health emergency; reduce symptoms; service member; sex; telehealth; trauma exposure; treatment as usual

Project Summary/Abstract Healthcare workers on the frontlines of the COVID-19 pandemic are experiencing unprecedented levels of stress and trauma exposure, resulting in exceptionally high rates (27-57%) of posttraumatic stress disorder (PTSD). Although Employee Assistance Programs (EAPs) have expanded their offerings to support healthcare workers during the pandemic, they lack the capacity to provide time-intensive first-line treatments for PTSD. To address this problem, the study team has adapted a standard first-line 12-session treatment into a brief, 4-6 session format (Prolonged Exposure for Primary Care; PE-PC) and demonstrated its efficacy in military service members. Given the rising tide of PTSD in frontline healthcare workers, there is an urgent need to test the effectiveness and subsequently implement PE-PC for this population by leveraging the existing resource of the healthcare system EAP. The long-term goal is to address COVID-19-related PTSD symptoms among healthcare workers and other vulnerable populations. The overall objective of this application is to demonstrate the effectiveness and identify barriers and facilitators to the implementation of PE-PC in healthcare system EAPs. The central hypothesis is that PE-PC will reduce COVID-19-related PTSD symptoms and improve functioning, compared to EAP Treatment as Usual (TAU). The rationale is that effectively treating COVID-19- related PTSD in the EAP setting is a scalable and cost-effective way to reduce healthcare worker distress and disability and will accrue downstream benefits to the healthcare organization and its patients. To accomplish the objective, this project will test the effectiveness of PE-PC, delivered by EAP counselors via telehealth, versus EAP TAU in 360 healthcare workers with PTSD at four southeast Michigan healthcare systems. This Hybrid Type 1 effectiveness-implementation trial will test the effectiveness of PE-PC and gather data regarding implementation through process evaluation and implementation mapping. The specific aims are: Specific Aim 1: Compare the effectiveness of PE-PC versus EAP TAU in reducing PTSD symptoms at 6-week (post- treatment), 3-, and 6-month follow-ups. Specific Aim 2: Compare the effectiveness of PE-PC versus EAP TAU in reducing burnout and improving job performance and functioning at 6-week, 3-, and 6-month follow-ups. Exploratory Aim 1: Confirm the mechanism and identify key mediators/moderators. Exploratory Aim 2: Conduct cost-effectiveness analysis. Exploratory Aim 3: Prepare for future implementation by conducting process evaluation and implementation mapping. This strategy will yield an implementation strategy that is targeted to address EAP-specific implementation barriers. This project is significant because it will contribute to the field a point-of-care intervention for frontline HCWs with COVID-19 related PTSD, thus improving clinical practice for this vulnerable population and increasing preparedness for future public health emergencies. This proposal is innovative because it will it will shift delivery of efficacious PTSD treatment from lengthy care in a traditional specialty care setting to brief treatment with a telehealth option in a frontline community setting.

项目概要/摘要 COVID-19 大流行前线的医护人员正在经历前所未有的水平 压力和创伤暴露，导致创伤后应激障碍的发病率极高（27-57%） （创伤后应激障碍）。尽管员工援助计划 (EAP) 已扩大其服务范围以支持医疗保健 疫情期间的工作人员，他们缺乏为创伤后应激障碍（PTSD）提供耗时的一线治疗的能力。到 为了解决这个问题，研究小组将标准的一线 12 次治疗调整为简短的 4-6 次治疗 会议形式（初级保健长期暴露；PE-PC）并展示了其在兵役中的功效 成员。鉴于一线医护人员中创伤后应激障碍（PTSD）的上升趋势，迫切需要测试 有效性，并随后利用现有资源为该人群实施 PE-PC 医疗保健系统EAP。长期目标是解决 COVID-19 相关的 PTSD 症状 医护人员和其他弱势群体。该应用程序的总体目标是展示 有效性并确定在医疗保健系统中实施 PE-PC 的障碍和促进因素 EAP。中心假设是 PE-PC 将减少与 COVID-19 相关的 PTSD 症状并改善 与常规 EAP 治疗 (TAU) 相比。理由是有效治疗 COVID-19- EAP 环境中的相关 PTSD 是一种可扩展且经济高效的方法，可减少医护人员的痛苦和 残疾，并将为医疗机构及其患者带来下游利益。为了完成 该项目将测试 EAP 顾问通过远程医疗提供的 PE-PC 的有效性， 密歇根州东南部四个医疗系统的 360 名患有 PTSD 的医护人员与 EAP TAU 进行比较。这 混合 1 型有效性实施试验将测试 PE-PC 的有效性并收集有关 通过流程评估和实施规划来实施。具体目标是： 具体目标 图 1：比较 PE-PC 与 EAP TAU 在 6 周（治疗后）减少 PTSD 症状方面的有效性 治疗）、3 个月和 6 个月的随访。具体目标 2：比较 PE-PC 与 EAP TAU 的有效性 在 6 周、3 和 6 个月的随访中减少倦怠并提高工作绩效和功能。 探索性目标1：确认机制并确定关键调解者/调节者。探索性目标 2：行为 成本效益分析。探索性目标 3：通过开展流程为未来的实施做好准备 评估和实施规划。该战略将产生一个实施战略，其目标是 解决 EAP 特定的实施障碍。该项目意义重大，因为它将为该领域做出贡献 对患有 COVID-19 相关 PTSD 的一线医护人员进行即时护理干预，从而改善临床实践 这一弱势群体，并加强对未来突发公共卫生事件的准备。这个提议是 创新是因为它将把有效的 PTSD 治疗从传统的长期护理中转移出来 专业护理机构在前线社区环境中通过远程医疗选项进行简短的治疗。