Samuelson Kristin W, Koenig Christopher J, McCamish Nicole, Choucroun Gerard, Tarasovsky Gary, Bertenthal Daniel, Seal Karen H
San Francisco Veterans Affairs Medical Center.
Department of Medicine, San Francisco Veterans Affairs Medical Center.
Psychol Serv. 2014 May;11(2):153-61. doi: 10.1037/a0034855. Epub 2013 Dec 23.
Veterans with posttraumatic stress disorder (PTSD) symptoms frequently present to primary care providers (PCPs) and are reluctant to seek out or accept referrals to specialty mental health care. Most PCPs have not been trained to assess for and manage symptoms of PTSD. Web-based programs are increasingly used for medical education, but there are no published evaluations of online PTSD trainings for PCPs. We developed a 70-min Web-based training that focused on military-related PTSD for PCPs practicing in Veterans Affairs (VA) hospitals, but was applicable to PCPs treating veterans and other trauma-exposed patients outside VA settings. The training consisted of four modules: (1) Detection and Assessment; (2) Comorbid Conditions and Related Problems; (3) Pharmacological Interventions; and (4) Psychotherapeutic Interventions. Clinical vignettes dramatized key training concepts. Seventy-three PCPs completed the training and assessments pre- and posttraining and 30 days later. Paired t tests compared change in PTSD-related knowledge and comfort with PTSD-related skills, and qualitative methods were used to summarize participant feedback. After the training, mean knowledge score improved from 46% to 75% items correct, with sustained improvement at 30 days. Thirty days posttraining, PCPs reported significantly greater comfort regarding PTSD-related skills assessed; 47% reported using training content in their clinical practice. Qualitatively, PCPs appreciated the flexibility of asynchronous, self-paced online modules, but suggested more interactive content. Given the numerous barriers to specialty mental health treatment, coupled with a preference among veterans with PTSD for accessing treatment through primary care, improving PTSD competency among PCPs may help better serve veterans' mental health needs.
患有创伤后应激障碍（PTSD）症状的退伍军人经常前往初级保健提供者（PCP）处就诊，并且不愿寻求或接受转介至专科心理健康护理。大多数初级保健提供者未接受过评估和管理创伤后应激障碍症状的培训。基于网络的项目越来越多地用于医学教育，但尚无针对初级保健提供者的在线创伤后应激障碍培训的公开评估。我们开发了一个70分钟的基于网络的培训，该培训聚焦于在退伍军人事务（VA）医院工作的初级保健提供者所面临的与军事相关的创伤后应激障碍，但也适用于在VA机构以外治疗退伍军人和其他有创伤经历患者的初级保健提供者。该培训包括四个模块：（1）检测与评估；（2）共病情况及相关问题；（3）药物干预；（4）心理治疗干预。临床案例使关键培训概念更加生动形象。73名初级保健提供者在培训前、培训后以及30天后完成了培训和评估。配对t检验比较了与创伤后应激障碍相关的知识变化以及对创伤后应激障碍相关技能的掌握程度，并用定性方法总结了参与者的反馈。培训后，平均知识得分从正确回答46%的题目提高到了75%，且在30天时仍持续提高。培训30天后，初级保健提供者报告称，在评估的与创伤后应激障碍相关的技能方面，他们的信心明显增强；47%的人报告在临床实践中使用了培训内容。从定性方面来看，初级保健提供者赞赏异步、自主学习的在线模块的灵活性，但建议增加更多互动内容。鉴于专科心理健康治疗存在诸多障碍，再加上患有创伤后应激障碍的退伍军人更倾向于通过初级保健获得治疗，提高初级保健提供者的创伤后应激障碍治疗能力可能有助于更好地满足退伍军人的心理健康需求。
