Valentine Sarah E, Fuchs Cara, Carlson Misha, Elwy A Rani
Department of Psychiatry, Boston Medical Center.
Center for Healthcare Organization and Implementation Research, Edith Nourse Rogers Memorial Veterans Hospital.
Psychol Trauma. 2022 Sep;14(6):914-923. doi: 10.1037/tra0001145. Epub 2021 Oct 18.
The implementation of evidence-based treatments (EBTs) to address posttraumatic stress disorder (PTSD) is a public health priority. Successful EBT implementation requires effective collaboration between multiple stakeholder groups, including hospital leaders, providers, and patients, to build buy-in for this effort. We describe our implementation science approach to meaningful stakeholder engagement, as part of a hybrid type I effectiveness-implementation trial of Skills Training in Affective and Interpersonal Regulation for PTSD treatment in primary care (STAIR-PC) at a large safety net hospital. We used primary care and patient community advisory boards (CABs) to interpret key informant interviews and identify strategies to adapt the intervention to ensure fit with the primary care setting. We documented our stakeholder engagement methodology through comprehensive field notes and minutes from CAB meetings, detailing the focus of meetings, suggestions for intervention and delivery adaptations, decision-making processes, and how disagreements about adaptations between stakeholders were resolved. To support replicability, we specify and operationalize implementation strategies to be used across each implementation phase of the trial. Key strategies involved a) ensuring that research questions are relevant to both patients and clinical providers; b) tailoring interventions that are flexible and adaptable to the needs of the local setting; c) continuous engagement of patients and providers throughout the implementation process; and d) building mutual respect, trust, and credibility between the research team, various provider groups, and patients. Our approach to engaging stakeholders informed an implementation blueprint to guide implementation of EBTs for PTSD in safety net hospital primary care clinics. (PsycInfo Database Record (c) 2022 APA, all rights reserved).
实施基于证据的治疗方法(EBTs)以解决创伤后应激障碍(PTSD)是一项公共卫生优先事项。成功实施EBT需要多个利益相关者群体(包括医院领导、医护人员和患者)之间进行有效的合作,以推动这项工作获得各方支持。我们描述了我们在一家大型安全网医院进行的一项混合I型有效性-实施试验(即初级保健中创伤后应激障碍治疗的情感与人际调节技能培训(STAIR-PC))中,让利益相关者有意义地参与进来的实施科学方法。我们利用初级保健和患者社区咨询委员会(CABs)来解读关键信息提供者访谈的内容,并确定调整干预措施的策略,以确保其适合初级保健环境。我们通过全面的实地记录和CAB会议记录记录了我们的利益相关者参与方法,详细说明了会议重点、干预措施和实施调整的建议、决策过程,以及利益相关者之间关于调整的分歧是如何解决的。为了支持可重复性,我们明确并实施了在试验的每个实施阶段都要使用的实施策略。关键策略包括:a)确保研究问题与患者和临床医护人员都相关;b)调整干预措施,使其灵活且能适应当地环境的需求;c)在整个实施过程中持续让患者和医护人员参与;d)在研究团队、不同医护人员群体和患者之间建立相互尊重、信任和信誉。我们让利益相关者参与的方法形成了一个实施蓝图,以指导在安全网医院初级保健诊所中实施针对创伤后应激障碍的EBTs。(PsycInfo数据库记录(c)2022美国心理学会,保留所有权利)