Barriers to and facilitators of using evidence-based, cognitive-behavioral anxiety interventions in integrated primary care practice.
Barriers to and facilitators of using evidence-based, cognitive-behavioral anxiety interventions in integrated primary care practice.
复制标题
在综合初级保健实践中使用基于证据的认知行为焦虑干预措施的障碍和促进因素。
DOI：
10.1037/ser0000696
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发表时间：
2023
影响因子：
2.3
通讯作者：
Maisto,StephenA
中科院分区：
文献类型：
--
作者：
Shepardson,RobynL;Fletcher,TerriL;Funderburk,JenniferS;Weisberg,RisaB;Beehler,GregoryP;Maisto,StephenA
在综合初级保健(IPC)中，对焦虑症和症状的认知行为治疗仍然没有得到充分利用，部分原因是为特殊护理开发的许多治疗方法并不容易转化为这种独特的环境。这项研究的目的是确定在IPC实践中，行为健康提供者(BHP)提供基于证据的认知-行为焦虑干预的障碍和促进者。我们对在退伍军人健康管理局IPC工作的18名BHP(50%的心理学家，33%的社会工作者，17%的注册护士)进行了半结构化的访谈。我们评估了使用心理教育、暴露、认知治疗、放松训练、正念/冥想、接受和承诺疗法的障碍和促进者，以及问题解决疗法。定性编码和传统内容分析揭示了三个层面的障碍和促进者：IPC、提供者和患者。主题指出了与IPC模型不适应的关键障碍、必和必拓培训不足、缺乏患者的认同、与IPC模型良好匹配的关键促进者(例如，范围、持续时间)、BHP感觉装备良好以及对患者的实用性。BHPS根据个体患者的适合度选择干预措施。一些结果与专科护理之前的工作一致，但IPC模式本身带来了重大的实施挑战。BHPS将受益于灵活的干预选择和关于IPC治疗目标的培训，以及如何以小剂量提供循证干预的实质。我们的发现将有助于为适应行为焦虑干预措施提供信息，以更好地适应IPC实践，并为BHP开发有益的培训和资源，以减少实施挑战。(心理信息数据库记录(C)2023年APA，保留所有权利)
Cognitive–behavioral treatment for anxiety disorders and symptoms remains underutilized in integrated primary care (IPC), in part because the many treatments developed for specialty care are not readily translated to this unique setting. The objective of this study was to identify barriers and facilitators to behavioral health providers (BHPs) delivering evidence-based cognitive-–behavioral anxiety interventions within IPC practice. We conducted semistructured interviews with a national sample of 18 BHPs (50% psychologists, 33% social workers, 17% registered nurses) working in IPC in the Veterans Health Administration. We assessed barriers to and facilitators of using psychoeducation, exposure, cognitive therapy, relaxation training, mindfulness/meditation, Acceptance and Commitment Therapy-based interventions, and problem-solving therapy. Qualitative coding and conventional content analysis revealed barriers and facilitators at three levels: IPC, provider, and patient. Themes suggested key barriers of poor fit with the IPC model, BHP training deficits, and lack of patient buy-in, and key facilitators of good perceived fit of the intervention (eg, scope, duration) with the IPC model, BHPs feeling well equipped, and utility for patients. BHPs select interventions based on fit for the individual patient. Some results were consistent with prior work from specialty care, but the IPC model itself introduces significant implementation challenges. BHPs would benefit from flexible intervention options and training on IPC treatment goals and how to deliver the essence of evidence-based interventions in small doses. Our findings will help to inform adaptation of behavioral anxiety interventions to better fit IPC practice and development of beneficial training and resources for BHPs to reduce implementation challenges.(PsycInfo Database Record (c) 2023 APA, all rights reserved)