Mental Health, South Texas Veterans Healthcare System, 116 A, 7400 Merton Minter Blvd, San Antonio, TX, USA.
Polytrauma Rehabilitation Center, San Antonio, TX, USA.
Psychiatr Q. 2020 Dec;91(4):1465-1478. doi: 10.1007/s11126-020-09767-w.
Posttraumatic stress disorder (PTSD) and comorbid mild traumatic brain injury (mTBI) are highly prevalent in veterans who served in Iraq [Operation Iraqi Freedom/Operation New Dawn] and Afghanistan [Operation Enduring Freedom]. Complicated psychotropic medications are used for treatment of PTSD and comorbid mTBI symptoms lead to polypharmacy related complications. Primary care providers (PCPs) working in Community Based Outpatient Clinics (CBOCs) are usually burdened with the responsibility of managing this complicated medication regimen or relevant side effects. The PCPs do not feel equipped to provide this complicated psychopharmacological management. Thus, there is a need for a comprehensive yet concise tool for the medication management of PTSD in veterans with comorbid mTBI. (1) To conduct focus groups of interdisciplinary team of experts and other stake holders to assess need, (2) To carefully review current VA/Department of Defense practice guideline to identify content, (3) To develop an evidence based, user friendly, and concise pocket guide for the PCP's. Content was identified by review of current guidelines and available literature and was finalized after input from stakeholders, multidisciplinary team of experts, and review of qualitative data from focus groups/interviews of clinicians working in remote CBOCs. The pocket tool was formatted and designed by multimedia service. A pocket guide in the form of a bi-fold, 4″ × 5.5″ laminated card was developed. One thousand hard copies were distributed in the local VA medical center. This product is available online for download at the South-Central Mental Illness Research, Education, and Clinical Center website ( https://www.mirecc.va.gov/VISN16/ptsd-and-mtbi-pocket-card.asp ). This pocket card provides PCPs an easy to carry and user-friendly clinical decision-making tool to effectively treat veterans with PTSD and comorbid mTBI.
创伤后应激障碍（PTSD）和合并轻度创伤性脑损伤（mTBI）在曾在伊拉克（伊拉克自由行动/新黎明行动）和阿富汗（持久自由行动）服役的退伍军人中非常普遍。治疗 PTSD 和合并 mTBI 症状的复杂精神药物会导致与多药治疗相关的并发症。在社区门诊诊所（CBOC）工作的初级保健提供者（PCP）通常承担着管理这种复杂药物治疗方案或相关副作用的责任。PCP 觉得自己没有能力提供这种复杂的精神药理学管理。因此，需要一种针对合并 mTBI 的 PTSD 退伍军人的综合而简洁的药物管理工具。（1）进行跨学科专家团队和其他利益相关者的焦点小组，以评估需求，（2）仔细审查当前的 VA/国防部实践指南，以确定内容，（3）为 PCP 开发基于证据、用户友好且简洁的袖珍指南。通过审查当前指南和现有文献来确定内容，并在利益相关者、多学科专家团队以及对在偏远 CBOC 工作的临床医生的焦点小组/访谈的定性数据进行输入后进行了最终确定。袖珍工具由多媒体服务进行格式化和设计。开发了一种折叠式、4"×5.5"的层压卡片形式的袖珍指南。在当地退伍军人事务医疗中心分发了 1000 份硬拷贝。该产品可在南中部分区心理健康研究、教育和临床中心网站（https://www.mirecc.va.gov/VISN16/ptsd-and-mtbi-pocket-card.asp）下载。这种袖珍卡在方便携带且易于使用的临床决策工具，可有效治疗患有 PTSD 和合并 mTBI 的退伍军人。
