Center for Mental Health Outcomes Research, Health Services Research and Development, Central Arkansas Veterans Healthcare System, North Little Rock, Arkansas.
South Central Mental Illness Education and Clinical Center, Central Arkansas Veterans Healthcare System, North Little Rock, Arkansas.
J Rural Health. 2017 Jun;33(3):290-296. doi: 10.1111/jrh.12230. Epub 2017 Jan 23.
Community-Based Outpatient Clinics (CBOCs) provide primary-care-based mental health services to rural veterans who live long distances from Veterans Affairs (VA) hospitals. Characterizing the composition of usual care will highlight the need and potential strategies to improve access to and engagement in evidence-based psychotherapy for posttraumatic stress disorder (PTSD).
Veterans (N = 132) with PTSD recruited from 5 large- (5,000-10,000 patients) and 6 medium-sized (1,500-4,999) CBOCs were enrolled in the usual care arm of a randomized control trial for a PTSD collaborative care study. Chart review procedures classified all mental health encounters during the 1-year study period into 10 mutually exclusive categories (7 psychotherapy and 3 medication management).
Seventy-two percent of participants received at least 1 medication management encounter with 30% of encounters being delivered via interactive video. More than half of veterans (58.3%) received at least 1 session of psychotherapy. Only 12.1% received a session of therapy classified as an evidence-based psychotherapy for PTSD. The vast majority of psychotherapy encounters were delivered in group format and only a small proportion were delivered via interactive video.
Findings suggest that veterans diagnosed with PTSD who receive their mental health treatment in large and medium CBOCs are likely to receive medication management, and very few veterans received evidence-based psychotherapy. There may be ways to increase access to evidence-based psychotherapy by expanding the use of interactive video to connect specialty mental health providers with patients, hosted either in CBOCs or in home-based care, and to offer more group-based therapies.
社区门诊（CBOC）为居住在远离退伍军人事务部（VA）医院的农村退伍军人提供基于初级保健的心理健康服务。描述常规护理的构成，将突出改善创伤后应激障碍（PTSD）循证心理治疗的可及性和参与度的必要性和潜在策略。
从 5 个大型（5000-10000 名患者）和 6 个中型（1500-4999 名患者）CBOC 招募了 PTSD 退伍军人（N=132），他们参加了 PTSD 合作护理研究的随机对照试验的常规护理组。病历回顾程序将 1 年研究期间的所有心理健康就诊分为 10 个互斥类别（7 种心理治疗和 3 种药物管理）。
72%的参与者至少接受了 1 次药物管理就诊，其中 30%通过互动视频进行。超过一半的退伍军人（58.3%）接受了至少 1 次心理治疗。只有 12.1%的治疗被归类为 PTSD 的循证心理治疗。绝大多数心理治疗是在小组形式下进行的，只有一小部分是通过互动视频进行的。
研究结果表明，在大型和中型 CBOC 接受精神健康治疗的 PTSD 诊断退伍军人可能会接受药物管理，而很少有退伍军人接受循证心理治疗。通过扩大互动视频的使用，将专业心理健康提供者与患者联系起来，无论是在 CBOC 还是在家庭护理中，以及提供更多的小组治疗，都可能增加获得循证心理治疗的机会。
