Mental Health, South Texas Veterans Healthcare System, Mail Code A116, 7400 Merton Minter Blvd., San Antonio, TX, 78229, USA.
Polytrauma Rehabilitation Center, Mail Code A116, 7400 Merton Minter Blvd., San Antonio, TX, 78229, USA.
Psychiatr Q. 2019 Dec;90(4):815-827. doi: 10.1007/s11126-019-09668-7.
(i) To describe an integrated model of psychiatric care for the treatment of posttraumatic stress disorder (PTSD) in veterans with mild traumatic brain injury (mTBI). (ii) To evaluate access to and engagement in psychiatric care among veterans with comorbid PTSD and mTBI after implementation of an Integrated Care (IC) model compared to the previous Usual Care (UC). 100 randomly selected charts, 50 from each of UC and IC were reviewed in this non-concurrent case- control study. Polytrauma Network Site (PNS), an outpatient rehabilitation clinic, for veterans who suffered from brain and other traumatic injuries at an urban VA Polytrauma Rehabilitation Center. Veterans receiving treatment for mTBI symptoms by the rehabilitation team were referred for medication management for PTSD to UC and IC. Co-located access to psychiatric care for medication management as part of the interdisciplinary team with the goal of expediting rehabilitation and functional recovery. Number of consults for psychiatric care for medication management scheduled and completed within 30 days, and number of veterans offered, initiating, and completing evidence-based psychotherapies for PTSD in UC compared to IC. After implementation of IC there were significant improvements in timely completion of consults and patient engagement with a psychiatrist. There also were improvements in number of referrals, initiation, and completion of evidence-based psychotherapies for the treatment of PTSD. IC within the PNS shows promise as an effective care model for increasing access and engagement in care for veterans with comorbid PTSD/mTBI. Future research is needed to examine the utility of this model in other sites.
(i) 描述一种综合精神科护理模式，用于治疗患有轻度创伤性脑损伤（mTBI）的退伍军人的创伤后应激障碍（PTSD）。(ii) 评估在实施综合护理（IC）模式后，患有 PTSD 和 mTBI 共病的退伍军人获得和参与精神科护理的情况，与之前的常规护理（UC）相比。在这项非同期病例对照研究中，对 100 份随机选择的病历进行了回顾，其中 UC 和 IC 各 50 份。该研究在退伍军人脑和其他创伤性损伤的城市退伍军人事务部创伤后康复中心的 Polytrauma Network Site（PNS）门诊康复诊所进行。接受康复团队治疗 mTBI 症状的退伍军人被转诊到 UC 和 IC 进行 PTSD 药物管理。为药物管理提供共置的精神科护理，作为多学科团队的一部分，目标是加快康复和功能恢复。在 30 天内安排和完成的精神科护理咨询次数，以及在 UC 与 IC 相比，为 PTSD 提供、开始和完成基于证据的心理治疗的退伍军人人数。实施 IC 后，及时完成咨询和患者与精神科医生合作的情况有了显著改善。转介、开始和完成 PTSD 治疗的基于证据的心理治疗的数量也有所增加。PNS 内的 IC 作为一种增加 PTSD/mTBI 共病退伍军人获得和参与护理的有效护理模式，显示出良好的前景。需要进一步研究该模型在其他场所的实用性。
