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在有或没有临床医生支持的情况下,在初级保健中使用创伤后应激障碍指导手册:一项试点随机对照试验。

Using PTSD Coach in primary care with and without clinician support: a pilot randomized controlled trial.

作者信息

Possemato Kyle, Kuhn Eric, Johnson Emily, Hoffman Julia E, Owen Jason E, Kanuri Nitya, De Stefano Leigha, Brooks Emily

机构信息

Center for Integrated Healthcare, Syracuse Veterans Affairs Medical Center, 800 Irving Avenue, Syracuse, NY 13210, USA.

National Center for Posttraumatic Stress Disorder, Dissemination and Training Division, Department of Veteran Affairs Palo Alto Health Care System, 3801 Miranda Avenue, Palo Alto, CA 94304, USA.

出版信息

Gen Hosp Psychiatry. 2016 Jan-Feb;38:94-8. doi: 10.1016/j.genhosppsych.2015.09.005. Epub 2015 Sep 25.

Abstract

OBJECTIVE

This study aims to evaluate the feasibility and potential effectiveness of two approaches to using the PTSD Coach mobile application in primary care: Self-Managed PTSD Coach and Clinician-Supported PTSD Coach. This study also aims to gather preliminary data to investigate if clinician support improves the benefits of using PTSD Coach on posttraumatic stress disorder (PTSD) severity and specialty mental healthcare utilization.

METHOD

Twenty primary care veterans with PTSD symptoms were randomized to either Self-Managed PTSD Coach consisting of one 10-min session providing instructions for application use or Clinician-Supported PTSD Coach consisting of four 20-min sessions focused on setting symptom reduction goals and helping veterans fully engage with application content.

RESULTS

Research procedures and intervention conditions appear feasible as indicated by high rates of assessment and intervention retention and high clinician fidelity and satisfaction. Both treatments resulted in reductions in PTSD symptoms, with 7 Clinician-Supported PTSD Coach and 3 Self-Managed PTSD Coach participants reporting clinically significant improvements. Clinician-Supported PTSD Coach resulted in more specialty PTSD care use postintervention and possibly greater reductions in PTSD symptoms.

CONCLUSIONS

Both PTSD Coach interventions are feasible and potentially helpful. The addition of clinician support appears to increase the effectiveness of self-management alone. A larger-scale randomized controlled trial is warranted to confirm these encouraging preliminary findings.

摘要

目的

本研究旨在评估在初级保健中使用创伤后应激障碍(PTSD)指导移动应用程序的两种方法的可行性和潜在效果:自我管理的PTSD指导和临床医生支持的PTSD指导。本研究还旨在收集初步数据,以调查临床医生的支持是否能提高使用PTSD指导对创伤后应激障碍(PTSD)严重程度和专科精神卫生保健利用的益处。

方法

20名有PTSD症状的初级保健退伍军人被随机分为两组,一组接受自我管理的PTSD指导,包括一次10分钟的课程,提供应用程序使用说明;另一组接受临床医生支持的PTSD指导,包括四次20分钟的课程,重点是设定症状减轻目标并帮助退伍军人充分参与应用程序内容。

结果

评估和干预保留率高,临床医生的忠诚度和满意度高,表明研究程序和干预条件可行。两种治疗方法均导致PTSD症状减轻,7名接受临床医生支持的PTSD指导和3名接受自我管理的PTSD指导的参与者报告有临床显著改善。临床医生支持的PTSD指导导致干预后更多地使用专科PTSD护理,并且可能更大程度地减轻PTSD症状。

结论

两种PTSD指导干预措施都是可行的,并且可能有帮助。增加临床医生的支持似乎会提高单独自我管理的效果。有必要进行一项更大规模的随机对照试验来证实这些令人鼓舞的初步发现。

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