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比较面对面和远程医疗服务提供模式的两项 PTSD 临床试验中的治疗效果和效率。

Impact and efficiency of treatment across two PTSD clinical trials comparing in-person and telehealth service delivery formats.

机构信息

Department of Psychiatry and Behavioral Sciences, Joe and Teresa Lozano Long School of Medicine, University of Texas Health Science Center at San Antonio.

VA San Diego Healthcare System.

出版信息

Psychol Serv. 2024 Feb;21(1):73-81. doi: 10.1037/ser0000774. Epub 2023 Jun 22.

Abstract

The intent of this study is to examine treatment impact and efficiency observed when cognitive behavioral treatments for posttraumatic stress disorder (PTSD) are delivered in-person or using telehealth. This study pooled data from 268 veterans enrolled in two PTSD clinical trials. In both trials, treatment was delivered using in-home telehealth ( arm), in-home in-person ( arm), and in-office care, where patients traveled to the Department of Veterans Affairs for either office-based telehealth or office-based in-person care ( arm). Average age was 44 ( = 12.57); 80.9% were males. The PTSD Checklist for (PCL-5) was used to assess symptom severity. Treatment impact was measured by (a) the proportion of participants who completed at least eight treatment sessions and (b) the proportion with a reliable change of ≥ 10 points on the PCL-5. Treatment efficiency was measured by the number of days required to reach the end point. The proportion of participants who attended at least eight sessions and achieved reliable change on the PCL-5 differed across treatment formats (s < .05). Participants in the in-home (75.4%) format were most likely to attend at least eight treatment sessions, followed by those in the telehealth (58.3%) and office (44.0%) formats, the latter of which required patients to travel. Participants in the in-home (68.3%, < .001) format were also more likely to achieve reliable change, followed by those in the telehealth (50.9%) and office (44.2%) formats. There were no significant differences in the amount of time to complete at least eight sessions. Delivery of therapy in-home results in a significantly greater likelihood of achieving both an adequate dose of therapy and a reliable decrease in PTSD symptoms compared to telehealth and office formats. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

摘要

本研究旨在探讨创伤后应激障碍(PTSD)认知行为治疗的现场治疗和远程医疗治疗效果和效率。本研究对两项 PTSD 临床试验中的 268 名退伍军人的数据进行了汇总。在两项试验中,均采用家庭远程医疗(臂)、家庭现场治疗(臂)和办公室治疗(臂),其中患者前往退伍军人事务部接受基于办公室的远程医疗或现场治疗。平均年龄为 44 岁(=12.57);80.9%为男性。采用创伤后应激障碍检查表 5 项版(PCL-5)评估症状严重程度。治疗效果通过以下指标进行衡量:(a)完成至少 8 次治疗的参与者比例,以及(b)PCL-5 上可靠变化≥10 分的参与者比例。治疗效率通过达到终点所需的天数来衡量。不同治疗模式下,参加至少 8 次治疗并在 PCL-5 上达到可靠变化的参与者比例存在差异(s<.05)。在家庭治疗(75.4%)模式下,参加至少 8 次治疗的参与者比例最高,其次是远程医疗(58.3%)和办公室(44.0%)模式,后者需要患者出行。在家庭治疗(68.3%,<.001)模式下,达到可靠变化的参与者比例也更高,其次是远程医疗(50.9%)和办公室(44.2%)模式。完成至少 8 次治疗所需的时间没有显著差异。与远程医疗和办公室治疗模式相比,家庭治疗方式更有可能达到足够的治疗剂量,并且 PTSD 症状得到可靠改善。

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本文引用的文献

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Virtual mental health care in the Veterans Health Administration's immediate response to coronavirus disease-19.
Am Psychol. 2021 Jan;76(1):26-38. doi: 10.1037/amp0000751. Epub 2020 Oct 29.
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