Brennan Laura A, Brady Julianne E, Drummond Karen L, Wiltsey-Stirman Shannon, Gutner Cassidy A, Iverson Katherine M
Women's Health Sciences Division, National Center for PTSD, VA Boston Healthcare System, 150 South Huntington Ave, Boston, MA, USA.
Women's Health Sciences Division, National Center for PTSD, VA Boston Healthcare System, 150 South Huntington Ave, Boston, MA, USA; Center for Healthcare Organization and Implementation Research (CHOIR), VA Boston Healthcare System, 150 South Huntington Ave, Boston, MA, USA.
Gen Hosp Psychiatry. 2022 Mar-Apr;75:54-60. doi: 10.1016/j.genhosppsych.2022.01.001. Epub 2022 Jan 17.
Uptake of Evidence-Based Psychotherapies (EBPs) by mental health (MH) clinicians, especially in community settings, remains highly variable. This formative pilot study aimed to understand the attitudes and practices of Veterans Health Administration community-based MH clinicians regarding EBPs and to identify multi-level factors that enable and hinder EBP implementation in this unique context.
Semi-structured interviews were conducted with MH clinicians (N = 40) working in community-based outpatient clinics (CBOCs) in metro/urban (n = 20) and non-metro/rural (n = 20) locations. Interviews were guided by the Consolidated Framework for Implementation Research and were analyzed using rapid content analysis. Results were organized by system-, clinician-, patient-, and innovation-levels.
EBPs were consistently perceived as important to delivering quality MH care, with most clinicians having received training in at least one VHA EBP. However, limited EBP training and consultation opportunities, inadequate autonomy to schedule EBP sessions, high and complex caseloads, and feelings of isolation at CBOCs decreased EPB use. Social workers perceived disparities in EBP training access relative to psychologists. Some barriers were more salient in non-metro/rural settings (e.g., patient-level privacy concerns).
Increased EBP training opportunities- particularly for social workers-, greater flexibility over schedules and caseloads, and more mechanisms for consultation and professional development may increase EBP uptake in community-based clinics.
心理健康（MH）临床医生，尤其是社区环境中的临床医生，对循证心理治疗（EBPs）的采用率仍然存在很大差异。这项形成性试点研究旨在了解退伍军人健康管理局社区心理健康临床医生对循证心理治疗的态度和做法，并确定在这一独特背景下促进和阻碍循证心理治疗实施的多层次因素。
对在大都市/城市（n = 20）和非大都市/农村（n = 20）地区的社区门诊诊所（CBOCs）工作的MH临床医生（N = 40）进行了半结构化访谈。访谈以实施研究综合框架为指导，并采用快速内容分析法进行分析。结果按系统、临床医生、患者和创新层面进行整理。
循证心理治疗一直被认为对提供高质量的心理健康护理很重要，大多数临床医生至少接受过一项退伍军人健康管理局循证心理治疗的培训。然而，循证心理治疗培训和咨询机会有限、安排循证心理治疗疗程的自主权不足、工作量高且复杂以及在社区门诊诊所感到孤立等因素降低了循证心理治疗的使用率。社会工作者认为在循证心理治疗培训机会方面相对于心理学家存在差距。一些障碍在非大都市/农村地区更为突出（例如患者层面的隐私担忧）。
增加循证心理治疗培训机会——特别是针对社会工作者的培训——、在日程安排和工作量方面给予更大灵活性，以及增加咨询和专业发展机制，可能会提高社区诊所对循证心理治疗的采用率。
