Department of Psychiatry, University of Arkansas for Medical Sciences, Little Rock, AR, USA.
Implement Sci. 2012 Mar 9;7:1-11. doi: 10.1186/1748-5908-7-14.
Investigators recently tested the effectiveness of a collaborative-care intervention for anxiety disorders: Coordinated Anxiety Learning and Management(CALM) []) in 17 primary care clinics around the United States. Investigators also conducted a qualitative process evaluation. Key research questions were as follows: (1) What were the facilitators/barriers to implementing CALM? (2) What were the facilitators/barriers to sustaining CALM after the study was completed?
Key informant interviews were conducted with 47 clinic staff members (18 primary care providers, 13 nurses, 8 clinic administrators, and 8 clinic staff) and 14 study-trained anxiety clinical specialists (ACSs) who coordinated the collaborative care and provided cognitive behavioral therapy. The interviews were semistructured and conducted by phone. Data were content analyzed with line-by-line analyses leading to the development and refinement of themes.
Similar themes emerged across stakeholders. Important facilitators to implementation included the perception of "low burden" to implement, provider satisfaction with the intervention, and frequent provider interaction with ACSs. Barriers to implementation included variable provider interest in mental health, high rates of part-time providers in clinics, and high social stressors of lower socioeconomic-status patients interfering with adherence. Key sustainability facilitators were if a clinic had already incorporated collaborative care for another disorder and presence of onsite mental health staff. The main barrier to sustainability was funding for the ACS.
The CALM intervention was relatively easy to incorporate during the effectiveness trial, and satisfaction was generally high. Numerous implementation and sustainability barriers could limit the reach and impact of widespread adoption. Findings should be interpreted with the knowledge that the ACSs in this study were provided and trained by the study. Future research should explore uptake of CALM and similar interventions without the aid of an effectiveness trial.
研究人员最近测试了一种焦虑症协作式护理干预措施（CALM）[])在美国各地的 17 家初级保健诊所的有效性。研究人员还进行了定性的过程评估。主要研究问题如下：(1) 实施 CALM 的促进因素/障碍是什么？(2) 研究结束后，CALM 的可持续性促进因素/障碍是什么？
对 47 名诊所工作人员（18 名初级保健提供者、13 名护士、8 名诊所管理人员和 8 名诊所工作人员）和 14 名接受过培训的焦虑症临床专家（ACS）进行了重点人物访谈，这些 ACS 协调协作式护理并提供认知行为疗法。访谈采用半结构化方式，并通过电话进行。数据采用逐行分析进行内容分析，从而形成和完善主题。
各利益相关者都出现了类似的主题。实施的重要促进因素包括实施负担低的认知、提供者对干预措施的满意度以及与 ACS 的频繁互动。实施的障碍包括提供者对心理健康的兴趣变化、诊所中兼职提供者的高比例以及社会经济地位较低的患者的高社会压力干扰了治疗的依从性。可持续性的主要促进因素是诊所是否已经为另一种疾病采用了协作式护理以及是否有现场心理健康工作人员。可持续性的主要障碍是 ACS 的资金。
在有效性试验中，CALM 干预措施相对容易实施，总体满意度较高。许多实施和可持续性障碍可能会限制其广泛应用的范围和影响。在了解该研究中的 ACS 是由研究提供和培训的情况下，应解释这些发现。未来的研究应探索在没有有效性试验的情况下，CALM 和类似干预措施的采用情况。
