Landoll Ryan R, Nielsen Matthew K, Waggoner Kathryn K
Department of Family Medicine, Uniformed Services University, 4301 Jones Bridge Road, Bethesda, MD 20814.
Air Command and Staff College, Air University, 55th LeMay Plaza South, Maxwell Air Force Base, AL 36112.
Mil Med. 2017 Mar;182(3):e1575-e1579. doi: 10.7205/MILMED-D-16-00272.
Integrated primary care behavioral health (PCBH) is a growing trend in health care delivery, particularly in the Department of Defense and the Department of Veterans Affairs. This consultative model has been applied within the U.S. Air Force for over 15 years and has demonstrated positive health impacts and patient satisfaction. With extended conflicts and engagements, including Operation Enduring Freedom and Operation Iraqi Freedom, deployment behavioral health care has expanded and positively received, but there is less empirical support of particular models of care in a deployed environment. Brief, solution-focused strategies commonly utilized in PCBH are likely to be particularly good candidates for the deployed environment. One key feature the Air Force's PCBH program is the collaborative team-based approach to care centered around a patient and driven by a primary care manager. This study expands the evaluation of the Air Force's PCBH program to include its novel application in a combat setting.
A retrospective review of 516 archival patient satisfaction surveys across Air Force military treatment facilities utilizing a PCBH program compared patient satisfaction surveys collected in a deployed environment at a large combat support hospital to noncombat facilities.
Results indicated that patient satisfaction in theater was comparable to satisfaction at Air Force military treatment facilities in noncombat environments, with one exception; patients seen in garrison rated higher satisfaction with the treatment plan than those seen in a deployed setting, F(509) = 5.36, p < 0.01, consistent with limited resources available in theater.
Given patient satisfaction across settings was found to be relatively equivalent, results suggests that the PCBH consultation model may be an appropriate model of care to meet a majority of the population's needs for a deployed environment. This pilot study has implications not only for military combat environments, but other austere settings, including civilian rural mental health settings. These findings inform provision of care in a deployed environment by demonstrating the benefits of the primary care behavioral model. Additionally, the Department of Veterans Affairs and other federal health care agencies will benefit from reviewing the structured and standardized PCBH model employed by the U.S. Air Force for nearly two decades as they expand care in rural mental health settings across the country.
综合初级保健行为健康（PCBH）是医疗服务领域中一种不断发展的趋势，在国防部和退伍军人事务部尤为如此。这种咨询模式在美国空军中已应用了15年以上，并已证明对健康有积极影响且患者满意度较高。随着持久自由行动和伊拉克自由行动等长期冲突与军事行动的开展，部署行为医疗服务有所扩展并受到好评，但在部署环境中，对于特定护理模式的实证支持较少。PCBH中常用的简短、以解决问题为重点的策略可能特别适合部署环境。美国空军PCBH项目的一个关键特征是以患者为中心、由初级保健经理推动的基于团队的协作式护理方法。本研究扩大了对美国空军PCBH项目的评估范围，将其在战斗环境中的新应用纳入其中。
对空军军事治疗设施中516份使用PCBH项目的档案患者满意度调查进行回顾性分析，将在大型战斗支援医院的部署环境中收集的患者满意度调查与非战斗设施的调查进行比较。
结果表明，战区内的患者满意度与空军非战斗环境下军事治疗设施的满意度相当，但有一个例外；驻地患者对治疗计划的满意度高于部署环境中的患者，F(509) = 5.36，p < 0.01，这与战区可用资源有限相一致。
鉴于不同环境下的患者满意度相对相当，结果表明PCBH咨询模式可能是满足大多数人在部署环境中护理需求的合适护理模式。这项试点研究不仅对军事战斗环境有意义，对其他严峻环境也有意义，包括农村民用心理健康环境。这些发现通过展示初级保健行为模式的益处，为在部署环境中提供护理提供了参考。此外，退伍军人事务部和其他联邦医疗保健机构在扩大全国农村心理健康环境护理服务时，将受益于审视美国空军近二十年来采用的结构化、标准化PCBH模式。
