Zatzick Douglas, O'Connor Stephen S, Russo Joan, Wang Jin, Bush Nigel, Love Jeff, Peterson Roselyn, Ingraham Leah, Darnell Doyanne, Whiteside Lauren, Van Eaton Erik
Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, Washington, USA.
Harborview Injury Prevention and Research Center, University of Washington School of Medicine, Seattle, Washington, USA.
J Trauma Stress. 2015 Oct;28(5):391-400. doi: 10.1002/jts.22041.
Posttraumatic stress disorder (PTSD) and its comorbidities are endemic among injured trauma survivors. Previous collaborative care trials targeting PTSD after injury have been effective, but they have required intensive clinical resources. The present pragmatic clinical trial randomized acutely injured trauma survivors who screened positive on an automated electronic medical record PTSD assessment to collaborative care intervention (n = 60) and usual care control (n = 61) conditions. The stepped measurement-based intervention included care management, psychopharmacology, and psychotherapy elements. Embedded within the intervention were a series of information technology (IT) components. PTSD symptoms were assessed with the PTSD Checklist at baseline prerandomization and again, 1-, 3-, and 6-months postinjury. IT utilization was also assessed. The technology-assisted intervention required a median of 2.25 hours (interquartile range = 1.57 hours) per patient. The intervention was associated with modest symptom reductions, but beyond the margin of statistical significance in the unadjusted model: F(2, 204) = 2.95, p = .055. The covariate adjusted regression was significant: F(2, 204) = 3.06, p = .049. The PTSD intervention effect was greatest at the 3-month (Cohen's effect size d = 0.35, F(1, 204) = 4.11, p = .044) and 6-month (d = 0.38, F(1, 204) = 4.10, p = .044) time points. IT-enhanced collaborative care was associated with modest PTSD symptom reductions and reduced delivery times; the intervention model could potentially facilitate efficient PTSD treatment after injury.
创伤后应激障碍（PTSD）及其共病在受伤的创伤幸存者中很常见。以往针对受伤后PTSD的协作护理试验已取得成效，但需要大量临床资源。本实用临床试验将在自动电子病历PTSD评估中筛查呈阳性的急性受伤创伤幸存者随机分为协作护理干预组（n = 60）和常规护理对照组（n = 61）。基于测量的分步干预包括护理管理、心理药理学和心理治疗要素。干预中嵌入了一系列信息技术（IT）组件。在随机分组前的基线时以及受伤后1个月、3个月和6个月时，使用PTSD检查表评估PTSD症状。还评估了IT的使用情况。技术辅助干预每位患者平均需要2.25小时（四分位间距 = 1.57小时）。该干预与症状适度减轻相关，但在未调整模型中超出了统计学显著性界限：F(2, 204) = 2.95，p = .055。协变量调整回归具有显著性：F(2, 204) = 3.06，p = .049。PTSD干预效果在3个月时最大（科恩效应量d = 0.35，F(1, 204) = 4.11，p = .044），在6个月时也最大（d = 0.38，F(1, 204) = 4.10，p = .044）。IT增强的协作护理与PTSD症状适度减轻和交付时间缩短相关；该干预模型可能有助于受伤后高效治疗PTSD。
