Conde Cristina, Zatzick Douglas, Wong Daisy, Russo Joan, Wang Jin, Engstrom Buggaveeti Allison, Hernandez Alexandra
Psychiatry. 2025 May 27:1-15. doi: 10.1080/00332747.2025.2503031.
The goal of this investigation was to assess the feasibility and acceptability of collaborative care intervention delivery for physically injured Spanish-speaking patients admitted to a level I trauma center.
The investigation was a secondary analysis of Spanish-speaking patients embedded within a larger comparative effectiveness trial. Participants were 22 male and female Spanish, non-English, speaking survivors of intentional and unintentional injuries, ages ≥18. Patients who were identified to be at elevated risk on the electronic health record evaluation were screened for ≥1 severe posttraumatic concern, and a score of ≥35 on the DSM-IV PTSD Checklist. Screen positive patients were randomized to collaborative care intervention versus enhanced usual care control conditions. The intervention included care management and evidence-based psychotherapeutic elements and pharmacotherapy targeting PTSD symptoms. The primary outcomes were PTSD symptoms, any post-injury concerns and emergency department/inpatient utilization over the 12-month post-injury period.
The pilot study achieved >75% follow-up rates at 1-3-, 6-, 9- and 12-months post-injury. Elements of the collaborative care intervention were feasibly delivered and acceptable to Spanish-speaking patients. Mixed-model regression analyses revealed no statistically significant intervention or control group differences for any of the three primary outcomes over the course of the 12 months after the injury for the intent-to-treat sample.
A collaborative care intervention for Spanish-speaking injury survivors with PTSD symptoms and multiple post-injury concerns was feasibly and acceptably delivered. The intervention warrants testing with a larger scale, adequately powered, randomized clinical trial.
本研究旨在评估为入住一级创伤中心的讲西班牙语的身体受伤患者提供协作式护理干预的可行性和可接受性。
本研究是对一项更大规模的比较有效性试验中的讲西班牙语患者进行的二次分析。参与者为22名讲西班牙语、非英语的有意和无意受伤幸存者，年龄≥18岁。在电子健康记录评估中被确定为高风险的患者，需筛查是否存在≥1种严重的创伤后问题，以及在《精神疾病诊断与统计手册》第四版创伤后应激障碍检查表上的得分是否≥35分。筛查呈阳性的患者被随机分为协作式护理干预组和强化常规护理对照组。干预措施包括护理管理、基于证据的心理治疗要素以及针对创伤后应激障碍症状的药物治疗。主要结局指标为创伤后应激障碍症状、受伤后的任何问题以及受伤后12个月内的急诊科/住院利用率。
在受伤后1、3、6、9和12个月时，试点研究的随访率>75%。协作式护理干预的各项要素能够切实提供给讲西班牙语的患者，且患者可接受。混合模型回归分析显示，在意向性治疗样本中，受伤后12个月内，对于三个主要结局指标中的任何一个，干预组和对照组之间均无统计学显著差异。
为有创伤后应激障碍症状和多种受伤后问题的讲西班牙语的受伤幸存者提供协作式护理干预是可行且可接受的。该干预措施值得通过更大规模、有足够效力的随机临床试验进行检验。
