Department of Pediatrics, Medical College of Wisconsin, Milwaukee, WI.
Departments of Psychiatry and Behavioral Medicine, and Family and Community Medicine, Medical College of Wisconsin, Milwaukee, WI.
Fam Med. 2021 Nov;53(10):843-856. doi: 10.22454/FamMed.2021.500263.
Traumatic experiences such as abuse, neglect, and household dysfunction have a lifetime prevalence of 62%-75% and can negatively impact health outcomes. However, many primary care providers (PCPs) are inadequately prepared to treat patients with trauma due to a lack of training. Our objective was to identify trauma-informed approach curricula for PCPs, review their effectiveness, and identify gaps.
We systematically identified articles from Medline, Scopus, Web of Science, Academic Search Premier, Cochrane, PsycINFO, MedEd Portal, and the STFM Resource Library. Search term headings "trauma-informed care (TIC)," "resilience," "patient-centered care," "primary care," and "education." Inclusion criteria were PCP, pediatric and adult patients, and training evaluation. Exclusion criteria were outside the United States, non-English articles, non-PCPs, and inpatient settings. We used the TIC pyramid to extract topics. We analyzed evaluation methods using the Kirkpatrick Model.
Researchers reviewed 6,825 articles and identified 17 different curricula. Understanding health effects of trauma was the most common topic (94%). Evaluation data revealed overall positive reactions and improved knowledge, attitudes, and confidence. Half (53%) reported Kirkpatrick level 3 behavior change evaluation outcomes with increased trauma screening and communication, but no change in referrals. Only 12% (2/17) evaluated Kirkpatrick level 4 patient satisfaction (significant results) and health outcomes (not significant).
Pilot findings from studies in our review show trauma-informed curricula for PCPs reveal positive reactions, an increase in knowledge, screening, communication, and patient satisfaction, but no change in referrals or health outcomes. Further research is needed to examine the impact of trainings on quality of care and health outcomes.
虐待、忽视和家庭功能障碍等创伤经历的终生患病率为 62%-75%，会对健康结果产生负面影响。然而，由于缺乏培训，许多初级保健提供者（PCP）在治疗创伤患者方面准备不足。我们的目的是确定针对 PCP 的创伤知情方法课程，评估其效果，并确定差距。
我们系统地从 Medline、Scopus、Web of Science、Academic Search Premier、Cochrane、PsycINFO、MedEd Portal 和 STFM 资源库中识别文章。搜索词标题为“创伤知情护理（TIC）”、“韧性”、“以患者为中心的护理”、“初级保健”和“教育”。纳入标准为 PCP、儿科和成人患者以及培训评估。排除标准为不在美国、非英语文章、非 PCP 和住院环境。我们使用 TIC 金字塔提取主题。我们使用 Kirkpatrick 模型分析评估方法。
研究人员审查了 6825 篇文章，确定了 17 种不同的课程。了解创伤对健康的影响是最常见的主题（94%）。评估数据显示，总体反应积极，知识、态度和信心有所提高。有一半（53%）报告了 Kirkpatrick 第 3 级行为改变评估结果，增加了创伤筛查和沟通，但转诊没有变化。只有 12%（2/17）评估了 Kirkpatrick 第 4 级患者满意度（显著结果）和健康结果（不显著）。
我们综述中的研究初步结果表明，针对 PCP 的创伤知情课程显示出积极的反应、知识的增加、筛查、沟通和患者满意度的提高，但转诊或健康结果没有变化。需要进一步研究培训对护理质量和健康结果的影响。
