Employing external facilitation to implement cognitive behavioral therapy in VA clinics: a pilot study
Employing external facilitation to implement cognitive behavioral therapy in VA clinics: a pilot study
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DOI：
10.1186/1748-5908-5-75
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发表时间：
2010-10-13
影响因子：
7.2
通讯作者：
Teasdale, Thomas A.
中科院分区：
文献类型：
--
作者：
Kauth, Michael R.;Sullivan, Greer;Teasdale, Thomas A.
背景资料：尽管十多年来医疗保健系统一直试图提供循证心理健康治疗，但心理治疗的可用性和使用率仍然很低。目前非常需要确定简单但有效的执行战略，以便在复杂的护理系统中采用复杂的做法。新出现的证据表明，促进可能是一个有效的综合实施战略，采用复杂的做法。目前的试点检查使用外部促进通过认知行为疗法（CBT）在20部退伍军人事务部（VA）clinics.Methods：20诊所配对设施的特点，和23名临床医生从这些CBT培训。每对中随机选择一个诊所接受外部促进。定量方法被用来检查CBT实施的程度，在10个诊所，接受外部促进相比，10个诊所，没有，并更好地了解个人提供者的特点和态度和他们的CBT使用之间的关系。外部促进的成本进行了评估，通过跟踪所花费的时间由促进者和治疗师在有关实施CBT的活动。定性方法被用来探索上下文和其他因素的影响implementation.Results：考试的变化scores显示，促进治疗师平均增加了19% [95%CI：（2，36）]，在自我报告的CBT使用从基线，而控制治疗师平均增加了4% [95%CI：（-14，21）]。与基线时未提供CBT的对照治疗师（10%）或基线时提供CBT的治疗师（平均3%）相比，基线时未提供CBT的易化条件下的治疗师显示出最大的增加（35%）。CBT使用的增加与之前的CBT培训无关。CBT实施的障碍是治疗师缺乏对他们的诊所时间表和临床leaders.Conclusions沟通不畅的控制：这些研究结果表明，促进可能有助于临床医生进行复杂的实践的变化，如实施循证心理治疗。此外，促进组中CBT使用的大幅增加是以适度的成本实现的。
Background: Although for more than a decade healthcare systems have attempted to provide evidence-based mental health treatments, the availability and use of psychotherapies remains low. A significant need exists to identify simple but effective implementation strategies to adopt complex practices within complex systems of care. Emerging evidence suggests that facilitation may be an effective integrative implementation strategy for adoption of complex practices. The current pilot examined the use of external facilitation for adoption of cognitive behavioral therapy (CBT) in 20 Department of Veteran Affairs (VA) clinics.Methods: The 20 clinics were paired on facility characteristics, and 23 clinicians from these were trained in CBT. A clinic in each pair was randomly selected to receive external facilitation. Quantitative methods were used to examine the extent of CBT implementation in 10 clinics that received external facilitation compared with 10 clinics that did not, and to better understand the relationship between individual providers' characteristics and attitudes and their CBT use. Costs of external facilitation were assessed by tracking the time spent by the facilitator and therapists in activities related to implementing CBT. Qualitative methods were used to explore contextual and other factors thought to influence implementation.Results: Examination of change scores showed that facilitated therapists averaged an increase of 19% [ 95% CI: (2, 36)] in self-reported CBT use from baseline, while control therapists averaged a 4% [ 95% CI: (-14, 21)] increase. Therapists in the facilitated condition who were not providing CBT at baseline showed the greatest increase (35%) compared to a control therapist who was not providing CBT at baseline (10%) or to therapists in either condition who were providing CBT at baseline (average 3%). Increased CBT use was unrelated to prior CBT training. Barriers to CBT implementation were therapists' lack of control over their clinic schedule and poor communication with clinical leaders.Conclusions: These findings suggest that facilitation may help clinicians make complex practice changes such as implementing an evidence-based psychotherapy. Furthermore, the substantial increase in CBT usage among the facilitation group was achieved at a modest cost.