VA Center for Integrated Healthcare, Syracuse VA Medical Center, Syracuse, NY, USA.
National Center for PTSD, Palo Alto, CA, USA.
J Gen Intern Med. 2023 Jul;38(Suppl 3):905-912. doi: 10.1007/s11606-023-08130-6. Epub 2023 Mar 17.
Posttraumatic stress disorder (PTSD) is common in primary care patients; however, evidence-based treatments are typically only available in specialty mental healthcare settings and often not accessed.
To test the effectiveness of a brief primary care-based treatment, Clinician-Supported PTSD Coach (CS PTSD Coach) was compared with Primary Care Mental Health Integration-Treatment as Usual (PCMHI-TAU) in (1) reducing PTSD severity, (2) engaging veterans in specialty mental health care, and (3) patient satisfaction with care.
Multi-site randomized pragmatic clinical trial.
A total of 234 veterans with PTSD symptoms who were not currently accessing PTSD treatment.
CS PTSD Coach was designed to be implemented in Veterans Affairs PCMHI and combines mental health clinician support with the "PTSD Coach" mobile app. Four 30-min sessions encourage daily use of symptom management strategies.
PTSD severity was measured by clinician-rated interviews pre- and post-treatment (8 weeks). Self-report measures assessed PTSD, depression, and quality of life at pretreatment, posttreatment, and 16- and 24-week follow-ups, and patient satisfaction at post-treatment. Mental healthcare utilization was extracted from medical records.
Clinician-rated PTSD severity did not differ by condition at post-treatment. CS PTSD Coach participants improved more on patient-reported PTSD severity at post-treatment than TAU participants (D = .28, p = .021). Coach participants who continued to have problematic PTSD symptoms at post-treatment were not more likely to engage in 2 sessions of specialty mental health treatment than TAU participants. Coach participants engaged in 74% more sessions in the intervention and reported higher treatment satisfaction than TAU participants (p < .001).
A structured 4-session intervention designed to align with patient preferences for care resulted in more patient-reported PTSD symptom relief, greater utilization of mental health treatment, and overall treatment satisfaction than TAU, but not more clinician-rated PTSD symptom relief or engagement in specialty mental health.
创伤后应激障碍（PTSD）在初级保健患者中很常见；然而，基于循证的治疗方法通常仅在专业的精神保健环境中可用，并且通常无法获得。
测试一种简短的基于初级保健的治疗方法的有效性，临床医生支持的 PTSD 教练（CS PTSD Coach）与初级保健心理健康整合-常规治疗（PCMHI-TAU）相比，（1）降低 PTSD 严重程度，（2）使退伍军人参与专业精神保健，以及（3）患者对护理的满意度。
多地点随机实用临床试验。
共有 234 名有 PTSD 症状但目前未接受 PTSD 治疗的退伍军人。
CS PTSD Coach 旨在在退伍军人事务部 PCMHI 中实施，将心理健康临床医生的支持与“PTSD Coach”移动应用程序相结合。四个 30 分钟的疗程鼓励日常使用症状管理策略。
通过治疗前后的临床医生评估访谈（8 周）测量 PTSD 严重程度。自我报告措施在治疗前、治疗后以及 16 周和 24 周随访时评估 PTSD、抑郁和生活质量，并在治疗后评估患者满意度。从医疗记录中提取精神保健利用率。
治疗后，临床医生评定的 PTSD 严重程度不因条件而异。CS PTSD Coach 参与者在治疗后自我报告的 PTSD 严重程度上的改善大于 TAU 参与者（D=0.28，p=0.021）。治疗后仍有明显 PTSD 症状的教练参与者与 TAU 参与者相比，更不可能接受 2 次专业心理健康治疗。教练参与者参与干预的次数增加了 74%，比 TAU 参与者报告的治疗满意度更高（p<0.001）。
一种结构化的 4 个疗程的干预措施旨在符合患者对护理的偏好，与 TAU 相比，患者报告的 PTSD 症状缓解更多，心理健康治疗的利用率更高，整体治疗满意度更高，但临床医生评定的 PTSD 症状缓解或专业心理健康参与度没有更高。
