Formative evaluation prior to implementation of a brief treatment for posttraumatic stress disorder in primary care.
Formative evaluation prior to implementation of a brief treatment for posttraumatic stress disorder in primary care.
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DOI：
10.1186/s43058-023-00426-2
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发表时间：
2023-05-04
影响因子：
--
通讯作者：
Elwy, A. Rani
中科院分区：
文献类型：
--
作者：
Valentine, Sarah E.;Fuchs, Cara;Olesinski, Elyse A.;Sarkisova, Natalya;Godfrey, Laura B.;Elwy, A. Rani
在初级保健中成功实施创伤后应激障碍（PTSD）的循证治疗（EBT）可以通过在新的和较少污名化的环境中提供护理来解决治疗机会和质量差距。然而，PTSD治疗在安全网初级保健中基本上是不可用的。我们的目的是收集临床医生利益相关者的数据，组织，态度和环境因素相关的EBT的实施。我们的发展形成性评价是由实施研究的综合框架（CFIR），包括（a）调查评估的实施环境和对EBT和行为健康整合的态度和（B）半结构化访谈，以确定实施的障碍和促进因素，并需要增强。参与者是医院员工（N = 22），包括初级保健医生（n = 6），综合行为健康临床医生（n = 8），社区健康倡导者（n = 3）和诊所领导（n = 5）。我们报告的频率和重复性的调查数据和调查结果的直接内容分析的采访。我们使用了一个并发的混合方法的方法，整合调查和访谈数据同时收集使用联合显示的方法。初级保健社区咨询委员会（CAB）帮助完善采访指南和解释调查结果。利益相关者描述了与干预特征（相对优势，适应性），外部环境（患者需求和资源），内部环境（网络和沟通，相对优先级，领导参与，可用资源）和个人参与（知识和信仰，文化因素）的CFIR领域相关的EBT的实施决定因素。利益相关者描述了强有力的态度支持（相对优势），但治疗师的时间和能力限制是主要的PTSD治疗实施障碍（可用资源）。医院管理的变化被认为是可能允许更多地获得行为健康服务，包括EBT。患者参与的障碍，如耻辱，不信任和护理偏好也被注意到（患者的需求和资源）。建议包括调整干预措施以满足现有的工作流程（适应性），系统调整工作重点是改善检测，转诊和护理协调过程（网络和通信），保护临床医生的培训和咨询时间（领导参与），并在实践中嵌入研究人员（可用资源）。我们的评估确定了在安全网综合初级保健环境中实施PTSD治疗的关键CFIR决定因素。我们的项目还表明，成功的实施需要利益相关者的大力参与。
Successful implementation of evidence-based treatments (EBT) for posttraumatic stress disorder (PTSD) in primary care may address treatment access and quality gaps by providing care in novel and less stigmatized settings. Yet, PTSD treatments are largely unavailable in safety net primary care. We aimed to collect clinician stakeholder data on organizational, attitudinal, and contextual factors relevant to EBT implementation. Our developmental formative evaluation was guided by the Consolidated Framework for Implementation Research (CFIR), including (a) surveys assessing implementation climate and attitudes towards EBTs and behavioral health integration and (b) semi-structured interviews to identify barriers and facilitators to implementation and need for augmentation. Participants were hospital employees (N = 22), including primary care physicians (n = 6), integrated behavioral health clinicians (n = 8), community wellness advocates (n = 3), and clinic leadership (n = 5). We report frequency and descriptives of survey data and findings from directed content analysis of interviews. We used a concurrent mixed-methods approach, integrating survey and interview data collected simultaneously using a joint display approach. A primary care community advisory board (CAB) helped to refine interview guides and interpret findings. Stakeholders described implementation determinants of the EBT related to the CFIR domains of intervention characteristics (relative advantage, adaptability), outer setting (patient needs and resources), inner setting (networks and communication, relative priority, leadership engagement, available resources), and individuals involved (knowledge and beliefs, cultural considerations). Stakeholders described strong attitudinal support (relative advantage), yet therapist time and capacity restraints are major PTSD treatment implementation barriers (available resources). Changes in hospital management were perceived as potentially allowing for greater access to behavioral health services, including EBTs. Patient engagement barriers such as stigma, mistrust, and care preferences were also noted (patient needs and resources). Recommendations included tailoring the intervention to meet existing workflows (adaptability), system alignment efforts focused on improving detection, referral, and care coordination processes (networks and communication), protecting clinician time for training and consultation (leadership engagement), and embedding a researcher in the practice (available resources). Our evaluation identified key CFIR determinants of implementation of PTSD treatments in safety net integrated primary care settings. Our project also demonstrates that successful implementation necessitates strong stakeholder engagement.
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影响因子：
3.2
作者：
Hsieh, HF;Shannon, SE
通讯作者：
Shannon, SE
影响因子：
3.6
作者：
Aarons, Gregory A.;Hoagwood, Kimberly;Landsverk, John;Glisson, Charles;Kelleher, Kelly;Cafri, Guy
通讯作者：
Cafri, Guy
DOI：
10.1186/1748-5908-4-50
发表时间：
2009-08-07
期刊：
Implementation science : IS
影响因子：
--
作者：
Damschroder LJ;Aron DC;Keith RE;Kirsh SR;Alexander JA;Lowery JC
通讯作者：
Lowery JC
影响因子：
7.2
作者：
Cook, Joan M.;O'Donnell, Casey;Schnurr, Paula P.
通讯作者：
Schnurr, Paula P.
DOI：
10.1023/b:mhsr.0000024351.12294.65
发表时间：
2004-06-01
期刊：
Mental health services research
影响因子：
--
作者：
Aarons, Gregory A
通讯作者：
Aarons, Gregory A