A repeated cross-sectional study of clinicians' use of psychotherapy techniques during 5years of a system-wide effort to implement evidence-based practices in Philadelphia
A repeated cross-sectional study of clinicians' use of psychotherapy techniques during 5years of a system-wide effort to implement evidence-based practices in Philadelphia
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DOI：
10.1186/s13012-019-0912-4
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发表时间：
2019-06-21
影响因子：
7.2
通讯作者：
Mandell, David S.
中科院分区：
文献类型：
--
作者：
Beidas, Rinad S.;Williams, Nathaniel J.;Mandell, David S.
背景很少有工作调查行为健康系统努力增加循证实践使用的影响，或者组织特征如何调节这些努力的效果。这项研究的目的是调查临床医生在一个鼓励实施循证实践的系统中超过5年的执业变化，以及组织特征如何缓和这种影响。我们假设循证技术将随着时间的推移而增加，而非基于证据的技术的使用将保持静态。方法使用重复横断面设计，从2013年到2017年在费城公共行为卫生系统收集了三次数据。对20家青少年行为卫生门诊的临床医生进行了为期5年的3次问卷调查(n=340，总应答率为60%)。从2013年到2017年，所有组织和临床医生都接受了循证实践创新中心提供的系统级支持。此外，大约一半的临床医生参加了城市资助的循证实践培训计划。结果80%的临床医生为女性，平均年龄为37.52岁(SD=11.40)；不同波之间的临床医生特征无显著差异(均为PS>；0.05)。控制了组织和临床医生的协变量，CBT技术的平均使用率从第一波(M=3.18)到第三波(M=3.37，p=.021，d=.29)增加了6%，而心理动力学技术(p=.570)没有变化。临床医生参与的每个循证实践培训计划都预测CBT的使用增加了3%(p=.019)，但在心理动力学技术的使用方面没有变化(p=.709)。在基线文化水平较高的组织中，与文化水平较低的组织相比，临床医生使用CBT的增加更多(增加8%，减少2%，p=.048)。结论循证实践的系统实施与临床医生实践的适度变化有关；这些影响受到组织特征的影响。调查结果确定了改进执行情况的初步目标。
BackgroundLittle work investigates the effect of behavioral health system efforts to increase use of evidence-based practices or how organizational characteristics moderate the effect of these efforts. The objective of this study was to investigate clinician practice change in a system encouraging implementation of evidence-based practices over 5years and how organizational characteristics moderate this effect. We hypothesized that evidence-based techniques would increase over time, whereas use of non-evidence-based techniques would remain static.MethodUsing a repeated cross-sectional design, data were collected three times from 2013 to 2017 in Philadelphia's public behavioral health system. Clinicians from 20 behavioral health outpatient clinics serving youth were surveyed three times over 5years (n=340; overall response rate = 60%). All organizations and clinicians were exposed to system-level support provided by the Evidence-based Practice Innovation Center from 2013 to 2017. Additionally, approximately half of the clinicians participated in city-funded evidence-based practice training initiatives. The main outcome included clinician self-reported use of cognitive-behavioral and psychodynamic techniques measured by the Therapy Procedures Checklist-Family Revised.ResultsClinicians were 80% female and averaged 37.52years of age (SD=11.40); there were no significant differences in clinician characteristics across waves (all ps>.05). Controlling for organizational and clinician covariates, average use of CBT techniques increased by 6% from wave 1 (M=3.18) to wave 3 (M=3.37, p=.021, d=.29), compared to no change in psychodynamic techniques (p=.570). Each evidence-based practice training initiative in which clinicians participated predicted a 3% increase in CBT use (p=.019) but no change in psychodynamic technique use (p=.709). In organizations with more proficient cultures at baseline, clinicians exhibited greater increases in CBT use compared to organizations with less proficient cultures (8% increase vs. 2% decrease, p=.048).ConclusionsSystem implementation of evidence-based practices is associated with modest changes in clinician practice; these effects are moderated by organizational characteristics. Findings identify preliminary targets to improve implementation.