Takamine Linda H, Hall Jennifer D, Cohen Deborah J, Danna Maria N, Hoeft Theresa J, Solberg Leif I, Bauer Amy M, Jakupcak Matthew, LaRocco-Cockburn Anna, Pfeiffer Paul N, Fortney John C
Department of Veterans Affairs, Health Services Research and Development, Center for Clinical Management Research.
Department of Family Medicine, Oregon Health and Science University.
Fam Syst Health. 2025 Mar;43(1):74-87. doi: 10.1037/fsh0000919.
To identify contributions made by care managers (CMs) to treatment for rural patients with posttraumatic stress disorder (PTSD) and bipolar disorder (BD), who are medically underserved and experiencing poverty, in a telepsychiatry collaborative care model.
We conducted an inductive qualitative study analyzing 24 semistructured interviews with patients who screened positive for PTSD or BD and participated in telepsychiatry collaborative care at 12 Federally Qualified Health Centers in Arkansas, Michigan, and Washington between November 2016 and June 2020. Interviews took place between March 2018 and June 2020.
Our findings confirmed that patients with PTSD and BD benefitted from the following collaborative care components, similarly to patients with more common depression and anxiety: individualized and practical treatment, playing an active role in treatment, and increased access. Our principal finding is one not yet fully explored in current research: CMs met patients' need to feel cared for, which may contribute to engagement and serve therapeutic ends. Feeling cared for emerged holistically from three components that occurred both within and outside therapeutic encounters: (a) interactional dynamics; (b) care management tasks; and (c) "nurturing connections" established with the CMs.
We addressed an understudied aspect of productive provider-patient relationships-patients' need to feel that providers care for them-and identified a range of actions and strategies that produce this feeling. CMs may be uniquely positioned to provide this type of care. For underserved segments of the population, leveraging these uniquely skilled clinical personnel could improve access, engagement, and outcomes. (PsycInfo Database Record (c) 2025 APA, all rights reserved).
在远程精神病学协作护理模式中，确定护理经理（CMs）对农村创伤后应激障碍（PTSD）和双相情感障碍（BD）患者治疗的贡献，这些患者在医疗服务方面不足且处于贫困状态。
我们进行了一项归纳性定性研究，分析了2016年11月至2020年6月期间在阿肯色州、密歇根州和华盛顿州的12家联邦合格健康中心对PTSD或BD筛查呈阳性并参与远程精神病学协作护理的患者进行的24次半结构化访谈。访谈于2018年3月至2020年6月期间进行。
我们的研究结果证实，PTSD和BD患者与更常见的抑郁症和焦虑症患者一样，从以下协作护理组成部分中受益：个性化且实用的治疗、在治疗中发挥积极作用以及增加就诊机会。我们的主要发现是当前研究中尚未充分探讨的一点：CMs满足了患者被关爱的需求，这可能有助于提高参与度并达到治疗目的。被关爱的感觉从治疗过程内外发生的三个组成部分中整体浮现出来：（a）互动动态；（b）护理管理任务；以及（c）与CMs建立的“滋养关系”。
我们探讨了医患关系中一个研究不足的方面——患者觉得医护人员关心他们的需求——并确定了一系列能产生这种感觉的行动和策略。CMs可能具有独特的地位来提供这种类型的护理。对于服务不足的人群，利用这些具有独特技能的临床人员可以改善就诊机会、提高参与度并改善治疗结果。（PsycInfo数据库记录（c）2025美国心理学会，保留所有权利）
