Zaccari Belle, Newell Summer, Wu Tiona Y, Newman Aurora, O'Neil Maya E, Kansagara Devan, Lovejoy Travis I
Center to Improve Veteran Involvement in Care, Veterans Affairs Portland Health Care System.
Psychol Serv. 2025 May 5. doi: 10.1037/ser0000968.
Despite the advantages of integrated care for co-occurring chronic pain and posttraumatic stress disorder (CP + PTSD), barriers impede its implementation. In this qualitative study, we examined facilitators and barriers of integrated care for CP + PTSD at a single Veterans Affairs medical center. We used purposive sampling and snowball recruitment to identify key stakeholders. We conducted semistructured interviews ( = 38) via video teleconferencing between January and May of 2022. We analyzed interview data employing both thematic and matrixed analysis methodologies. We interviewed VA staff (providers [ = 11], clinic managers [ = 5], and administrators [ = 2]) and patients with CP + PTSD ( = 19). There were three main findings: (a) current models disconnect care for CP + PTSD and fail in fully addressing the intricacies of this comorbidity, (b) the interconnection of CP + PTSD symptoms supports the need to overcome barriers to integrated treatment, and (c) facility- and system-level barriers to implementation of integrated care include staffing and having an evidence-based protocol. Staff and patient stakeholders recognized growing momentum supporting the development of integrated, nonpharmacological treatments for CP + PTSD. However, interventions to address barriers are needed to increase wider adoption and implementation. (PsycInfo Database Record (c) 2025 APA, all rights reserved).
尽管针对慢性疼痛与创伤后应激障碍共病(CP + PTSD)的综合护理具有诸多优势,但仍存在阻碍其实施的障碍。在这项定性研究中,我们考察了一家退伍军人事务医疗中心针对CP + PTSD的综合护理的促进因素和障碍。我们采用目的抽样和滚雪球式招募的方法来确定关键利益相关者。在2022年1月至5月期间,我们通过视频电话会议进行了半结构化访谈(n = 38)。我们运用主题分析和矩阵分析方法对访谈数据进行了分析。我们采访了退伍军人事务部的工作人员(提供者[n = 11]、诊所经理[n = 5]和管理人员[n = 2])以及患有CP + PTSD的患者(n = 19)。有三个主要发现:(a)当前模式将CP + PTSD的护理割裂开来,未能充分解决这种共病的复杂性;(b)CP + PTSD症状的相互关联支持了克服综合治疗障碍的必要性;(c)综合护理实施的机构和系统层面的障碍包括人员配备和拥有基于证据的方案。工作人员和患者利益相关者认识到,支持为CP + PTSD开发综合非药物治疗的势头日益增强。然而,需要采取干预措施来消除障碍,以扩大其采用和实施范围。(PsycInfo数据库记录(c)2025美国心理学会,保留所有权利)