Lindsay Jan A, Hudson Sonora, Martin Lindsey, Hogan Julianna B, Nessim Miryam, Graves Lauren, Gabriele Jeanne, White Donna
Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety (MEDVAMC 152), 2002 Holcombe Blvd, Houston, TX 77030, USA.
Baylor College of Medicine, One Baylor Plaza Houston, TX 77030, USA.
J Technol Behav Sci. 2017 Dec;2(3-4):140-148. doi: 10.1007/s41347-017-0032-4. Epub 2017 Nov 28.
This clinical demonstration project used facilitation to implement VA Video to Home (VTH) to deliver evidence-based psychotherapies to underserved rural Veterans, to increase access to mental health care. Participants were Veterans seeking mental health treatment at "Sonny" Montgomery Veterans Affairs Medical Center in Jackson, MS, and/or its six community-based outpatient clinics. Measures included patient encounter and demographic data, patient and provider interviews, reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) factors, measures of fidelity to manualized evidence-based psychotherapies (EBPs), and qualitative interviews. The project was deemed feasible; 93 (67 men, 26 women, including 77 rural, 16 urban) patients received weekly EBPs via VTH. Nearly half were Black 46), 36 of whom (78.3%) were also rural. Fifty-three (48.4%) were Operation Enduring Freedom/Operation Iraqi Freedom Veterans. Ages varied widely, from 20 to 79 years. Primary diagnoses included posttraumatic stress disorder (41), depressive disorders (22), anxiety disorders (nine), insomnia (eight), chronic pain (eight), and substance use disorder (five). Fifteen clinicians were trained to deliver eight EBPs via VTH. Growth in number of Veterans treated by telehealth was 10.12 times and mental health visits were 7.34 times greater than the national annual average of growth for telehealth at VHA facilities. Illustrative examples and qualitative data from both patients and providers suggested overall satisfaction with VTH. This demonstrates the benefits of VTH for increasing access to mental health treatment for rural patients and advantages of an implementation facilitation strategy using an external facilitator. Continuing research should clarify whether certain patients are more likely to participate than others and whether certain EBPs are more easily delivered with VTH than others.
这个临床示范项目利用促进手段来实施退伍军人事务部的视频到家（VTH）服务，以便为服务不足的农村退伍军人提供循证心理治疗，从而增加获得心理健康护理的机会。参与者是在密西西比州杰克逊市的“桑尼”蒙哥马利退伍军人事务医疗中心及其六个社区门诊诊所寻求心理健康治疗的退伍军人。测量指标包括患者诊疗及人口统计学数据、患者和提供者访谈、覆盖范围、有效性、采用情况、实施情况和维持情况（RE-AIM）因素、对手册化循证心理治疗（EBPs）的保真度测量以及定性访谈。该项目被认为是可行的；93名患者（67名男性，26名女性，包括77名农村患者和16名城市患者）通过VTH接受了每周一次的循证心理治疗。近一半是黑人（46名），其中36名（78.3%）也是农村患者。53名（48.4%）是持久自由行动/伊拉克自由行动退伍军人。年龄跨度很大，从20岁到79岁。主要诊断包括创伤后应激障碍（41例）、抑郁症（22例）、焦虑症（9例）、失眠（8例）、慢性疼痛（8例）和物质使用障碍（5例）。15名临床医生接受了通过VTH提供8种循证心理治疗的培训。通过远程医疗治疗的退伍军人数量增长是退伍军人健康管理局（VHA）设施远程医疗全国年平均增长的10.12倍，心理健康就诊次数是其7.34倍。来自患者和提供者的示例及定性数据表明对VTH总体满意。这证明了VTH在增加农村患者获得心理健康治疗机会方面的益处以及使用外部促进者的实施促进策略的优势。持续的研究应阐明某些患者是否比其他患者更有可能参与，以及某些循证心理治疗是否比其他治疗更易于通过VTH提供。
