Delivering Written Exposure Therapy for PTSD in Underserved Primary Care Settings

在服务不足的初级保健机构中为 PTSD 提供书面暴露疗法

基本信息

批准号：
10657736
负责人：
Lisa Seidel Meredith
金额：
$ 133.17万
依托单位：
RAND CORPORATION
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-09-13 至 2026-06-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10657736
关键词：
Address Adoption Adult Affect Age Anxiety Boston Caring Characteristics Clinic Clinical Cognitive Communities Consultations Data Effectiveness Eligibility Determination Environment Exhibits Extinction Eye Movements Federally Qualified Health Center Fright Gender General Population Geography Health Services Accessibility Individual Intervention Interview Literature Maintenance Managed Care Mediating Mediator Medicaid Medical Medicare Mental Depression Mental Health Mental Health Services Methods Monitor Nature Neighborhood Health Center Outcome Participant Patient Outcomes Assessments Patient-Focused Outcomes Patients Post-Traumatic Stress Disorders Prevalence Primary Care Process Productivity Provider Psychotherapy Public Health Quality of Care Randomized Randomized, Controlled Trials Reach, Effectiveness, Adoption, Implementation, and Maintenance Research Resources Severities Societies Supervision Symptoms Therapeutic Intervention Time Training Trauma Treatment outcome Underserved Population Universities Work Writing behavioral health collaborative care comorbidity cost depressive symptoms desensitization design effectiveness evaluation effectiveness testing effectiveness validation effectiveness/implementation design effectiveness/implementation trial evidence base follow-up implementation context implementation evaluation implementation outcomes implementation process improved improved outcome medical schools post intervention primary care patient primary care setting primary outcome safety net secondary outcome

项目摘要

PROJECT SUMMARY Posttraumatic stress disorder (PTSD) results in substantial costs to society is highly prevalent among adults. Importantly, the prevalence PTSD within primary care settings is even higher than the general population as primary care is the setting to which individuals with PTSD most often present. Evidence-based psychotherapies (EBPs) for PTSD are available but dissemination within real world settings is fraught with challenges because these therapies require 10-15, lengthy treatment sessions and extensive therapist training to implement, and these treatments are not feasible within primary care settings given the limited time resources. Consequently, there are multiple barriers to accessing EBPs for PTSD. Efforts to integrate mental health services within primary care for PTSD though collaborative care management (CoCM) interventions are rapidly expanding and have been shown to be effective in the treatment of depression and anxiety. However, the evidence for PTSD is limited due to the time intensive nature of the PTSD therapy approaches that have been examined. An efficient PTSD treatment approach is needed to address the treatment needs of individuals with PTSD presenting to primary care. Written exposure therapy (WET) is a brief EBP that provides an alternative to more intensive EBPs. Recent studies of WET have yielded positive outcomes and have shown it to be non-inferior when directly compared to more time intensive PTSD EBPs, but WET has not yet been examined within the primary care environment. The primary aims of the proposed study are to evaluate the effectiveness and implementation of delivering WET into CoCM to improve the management of PTSD among underserved primary care patients in Federally Qualified Health Centers (FQHCs). The pragmatic cluster- randomized study will use a hybrid effectiveness-implementation design. Twelve FQHCs will be randomized to either CoCM plus WET (CoCM+WET) or CoCM alone and 60 patients within each FQHC will be screened for eligibility. We will use the RE-AIM framework (for Reach, Efficacy/Effectiveness, Adoption, Implementation, & Maintenance) to evaluate the effectiveness and implementation process of the CoCM+WET intervention using mixed methods. To examine effectiveness and potential mediators and moderators of the intervention, we will administer assessments at baseline, 3- and 6-month follow-up. To assess implementation, we will use clinic process data and clinic staff interviews pre- and post-intervention. This study has the potential to substantially impact practice and public health by validating the effectiveness and feasibility of delivering a brief trauma- focused EBP embedded within CoCM in primary care to improve PTSD outcomes for underserved patients.

项目摘要创伤后应激障碍（PTSD）在成年人中高度普遍为社会带来巨大的成本。重要的是，初级保健环境中PTSD的患病率甚至高于一般人群初级保健是最经常出现PTSD的人的环境。循证可用于PTSD的心理治疗（EBP），但现实世界中的传播充满了挑战是因为这些疗法需要10-15，冗长的治疗课程和广泛的治疗师培训实施，在有限的时间内，这些治疗在初级保健环境中是不可行的资源。因此，访问PTSD的EBP有多个障碍。整合心理的努力尽管协作护理管理（COCM）干预措施是PTSD的基础医疗保健服务快速扩张，已被证明可以有效治疗抑郁和焦虑。然而， PTSD的证据受到限制，这是由于具有PTSD治疗方法的时间密集型性质被检查。需要一种有效的PTSD治疗方法来满足个人的治疗需求 PTSD向初级保健呈现。书面暴露疗法（湿）是一个简短的EBP 替代更密集的EBP。最近对湿的研究产生了积极的结果，并表明了直接与更多时间密集的PTSD EBP进行比较时，是非内部的，但湿在初级保健环境中进行检查。拟议研究的主要目的是评估将湿湿的有效性和实施为COCM，以改善PTSD的管理在联邦资格卫生中心（FQHCS）中服务不足的初级保健患者。务实的集群随机研究将使用混合有效性实施设计。十二个FQHC将被随机分为 COCM加湿（COCM+湿）或单独使用COCM和每个FQHC中的60名患者将被筛选合格。我们将使用RE-AIM框架（用于触及，有效性/有效性，采用，实施＆维护）使用COCM+湿干预的有效性和实施过程混合方法。为了检查干预措施的有效性以及潜在的调解人和主持人，我们将在基线，3个月和6个月的随访时进行管理评估。为了评估实施，我们将使用诊所处理数据和诊所工作人员进行干预前后的访谈。这项研究有可能通过验证短暂创伤的有效性和可行性来影响实践和公共卫生聚焦的EBP嵌入了COCM中的初级保健中，以改善服务不足患者的PTSD结局。