Expanding the reach of evidence-based mental health interventions to private practice: Qualitative assessment using a policy ecology framework.
Expanding the reach of evidence-based mental health interventions to private practice: Qualitative assessment using a policy ecology framework.
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DOI：
10.3389/frhs.2022.892294
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发表时间：
2022
期刊：
影响因子：
--
通讯作者：
Benito, Kristen G
中科院分区：
文献类型：
--
作者：
Frank, Hannah E;Milgram, Lauren;Freeman, Jennifer B;Benito, Kristen G
在常规临床实践中，针对精神健康障碍的循证干预措施（EBI）未得到充分利用。焦虑症的暴露疗法是一个特别难以实施的EBI，有强大的经验支持。以前的研究已经研究了EBI实施的决定因素在公共资助的心理健康设置，但很少有研究探讨EBI实施的决定因素在私人执业环境。私人执业临床医生可能面临独特的实施障碍，包括设置EBI使用的特定背景障碍。政策生态框架考虑了广泛的系统性决定因素，包括组织，监管，社会和政治背景，这可能与EBI在私人执业环境中的实施有关，但尚未在以前的研究中进行过研究。定性访谈进行评估私人执业临床医生的EBI实施的决定因素，使用政策生态框架的看法。临床医生被问及广泛实施心理健康EBI和暴露疗法。混合方法分析比较了来自单独与集体私人执业的临床医生以及报告对暴露疗法的高与低组织支持的临床医生的反应。回应强调了在私人执业中实施EBI的几个障碍和促进因素。例子包括与组织支持有关的决定因素（例如，使用EBI的同事），付款人限制（例如，缺乏对较长会议的补偿），财政激励措施（例如，支付参加培训），以及消费者对EBI的需求。有显着的差异，临床医生所面临的障碍，谁在集团私人执业相比，那些工作在单独的做法。单独的私人执业临床医生描述了他们的执业环境限制他们的同事支持程度的方式（例如，用于咨询或暴露治疗计划），同时还允许灵活性（例如，在他们的时间表和实践地点），这可能是临床医生在小组实践中不可用的。使用政策生态框架提供了一个广泛的理解，影响私人执业临床医生使用EBI的背景因素，包括暴露疗法。调查结果指出，潜在的实施策略，可以解决的障碍，是独特的临床医生在私人执业。
Evidence-based interventions (EBIs) for mental health disorders are underutilized in routine clinical practice. Exposure therapy for anxiety disorders is one particularly difficult-to-implement EBI that has robust empirical support. Previous research has examined EBI implementation determinants in publicly funded mental health settings, but few studies have examined EBI implementation determinants in private practice settings. Private practice clinicians likely face unique barriers to implementation, including setting-specific contextual barriers to EBI use. The policy ecology framework considers broad systemic determinants, including organizational, regulatory, social, and political contexts, which are likely relevant to EBI implementation in private practice settings but have not been examined in prior research. Qualitative interviews were conducted to assess private practice clinicians' perceptions of EBI implementation determinants using the policy ecology framework. Clinicians were asked about implementing mental health EBIs broadly and exposure therapy specifically. Mixed methods analyses compared responses from clinicians working in solo vs. group private practice and clinicians who reported high vs. low organizational support for exposure therapy. Responses highlight several barriers and facilitators to EBI implementation in private practice. Examples include determinants related to organizational support (e.g., colleagues using EBIs), payer restrictions (e.g., lack of reimbursement for longer sessions), fiscal incentives (e.g., payment for attending training), and consumer demand for EBIs. There were notable differences in barriers faced by clinicians who work in group private practices compared to those working in solo practices. Solo private practice clinicians described ways in which their practice setting limits their degree of colleague support (e.g., for consultation or exposure therapy planning), while also allowing for flexibility (e.g., in their schedules and practice location) that may not be available to clinicians in group practice. Using the policy ecology framework provides a broad understanding of contextual factors that impact private practice clinicians' use of EBIs, including exposure therapy. Findings point to potential implementation strategies that may address barriers that are unique to clinicians working in private practice.
影响因子：
3.8
作者：
Candon, Molly;Williams, Nathaniel;Zentgraf, Kelly;Buttenheim, Alison;Bewtra, Meenakshi;Beidas, Rinad S.;Stewart, Rebecca E.
通讯作者：
Stewart, Rebecca E.
影响因子：
3.8
作者：
Cho, Evelyn;Tugendrajch, Siena K.;Marriott, Brigid R.;Hawley, Kristin M.
通讯作者：
Hawley, Kristin M.