Fortney John C, Rajan Suparna, Reisinger Heather S, Moeckli Jane, Nolan John P, Wong Edwin S, Rise Peter, Petrova Valentina V, Sayre George G, Pyne Jeffrey M, Grubaugh Anouk, Simsek-Duran Fatma, Grubbs Kathleen M, Morland Leslie A, Felker Bradford, Schnurr Paula P
VA HSR&D Center for Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA, United States of America; Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, United States of America.
VA HSR&D Center for Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA, United States of America.
Gen Hosp Psychiatry. 2022 Jul-Aug;77:109-117. doi: 10.1016/j.genhosppsych.2022.03.009. Epub 2022 Mar 26.
To address barriers to trauma-focused psychotherapy for veterans with posttraumatic stress disorder (PTSD), we compared two implementation strategies to promote the deployment of telemedicine collaborative care.
We conducted a Hybrid Type III Effectiveness Implementation trial at six VA medical centers and their 12 affiliated Community Based Outpatient Clinics. The trial used a stepped wedge design and an adaptive implementation strategy that started with standard implementation, followed by enhanced implementation for VA medical centers that did not achieve the performance benchmark. Implementation outcomes for the 544 veterans sampled from the larger population targeted by the intervention were assessed from chart review (care management enrollment and receipt of trauma-focused psychotherapy) and telephone survey (perceived access and PTSD symptoms) after each implementation phase. The primary outcome was enrollment in care management.
There was no significant difference between standard implementation and enhanced implementation on any of the implementation outcomes. 41.6% of sampled veterans had a care manager encounter, but only 6.0% engaged in trauma-focused psychotherapy.
While telemedicine collaborative care was shown to be effective at engaging veterans in trauma-focused psychotherapy in a randomized controlled trial, neither standard nor enhanced implementation strategies were sufficient to support successful deployment into routine care.
ClinicalTrials.gov Identifier: NCT02737098.
为解决创伤后应激障碍（PTSD）退伍军人接受创伤聚焦心理治疗的障碍，我们比较了两种实施策略，以促进远程医疗协作护理的应用。
我们在六个退伍军人事务部（VA）医疗中心及其12个附属社区门诊诊所进行了一项III型混合有效性实施试验。该试验采用阶梯楔形设计和适应性实施策略，开始时采用标准实施，随后对未达到绩效基准的VA医疗中心进行强化实施。在每个实施阶段后，通过病历审查（护理管理登记和接受创伤聚焦心理治疗情况）和电话调查（感知的可及性和PTSD症状）对从干预目标的更大人群中抽取的544名退伍军人的实施结果进行评估。主要结果是护理管理登记情况。
在任何实施结果方面，标准实施和强化实施之间均无显著差异。41.6%的抽样退伍军人与护理经理有接触，但只有6.0%接受了创伤聚焦心理治疗。
虽然在一项随机对照试验中表明远程医疗协作护理在使退伍军人参与创伤聚焦心理治疗方面是有效的，但标准实施策略和强化实施策略均不足以支持成功应用于常规护理。
ClinicalTrials.gov标识符：NCT02737098。
