EARLY TREATMENT WITHDRAWAL FROM EVIDENCE-BASED PSYCHOTHERAPY FOR PTSD: TELEMEDICINE AND IN-PERSON PARAMETERS
EARLY TREATMENT WITHDRAWAL FROM EVIDENCE-BASED PSYCHOTHERAPY FOR PTSD: TELEMEDICINE AND IN-PERSON PARAMETERS
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DOI：
10.2190/pm.48.1.d
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发表时间：
2014-01-01
影响因子：
2
通讯作者：
Acierno, Ron
中科院分区：
文献类型：
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作者：
Hernandez-Tejada, Melba A.;Zoller, James S.;Acierno, Ron
目的：确定退伍军人创伤后应激障碍（PTSD）循证治疗的远程医疗与面对面治疗相关的治疗完成障碍的差异。方法：本研究来自两项正在进行的随机对照试验（RCT），比较了PTSD暴露治疗的面对面与远程医疗交付。对从这两项研究的治疗阶段退出的参与者进行了一次性电话评估，测量重点是报告的退出原因，以及治疗方式的舒适度和有效性。通过卡方和逻辑回归分析二分数据;通过ANOVA分析连续数据。结果：69名总辍学者中有47人参加了研究。两种方式之间的脱落率没有差异。接受面对面暴露治疗的参与者中有更大比例的人报告了护理后勤方面的困难（例如，停车场），而接受远程医疗治疗的参与者中有更大比例的人报告难以忍受治疗的某些压力方面;然而，接受远程医疗提供的治疗的人在退出之前完成了更多的疗程。在这两种情况下的参与者报告说，他们喜欢他们的治疗师，并有信心的结论：辍学的原因根据不同类型的治疗交付。建议为今后的研究中，根据交付方式的治疗方案的修改。
Objective: To determine differences in reported barriers to treatment completion associated with telemedicine vs. in-person delivery of evidence-based treatment for PTSD in combat veterans. Method: The present study was derived from two ongoing randomized controlled trials (RCTs) comparing in-person vs. telemedicine delivery of exposure therapy for PTSD. A one-time telephone assessment of participants who dropped out from the treatment phase of these two studies was conducted, with measures focusing on reported reasons for dropout, and perceived comfort and efficacy of the treatment modality. Dichotomous data were analyzed via chi-square and logistic regression; continuous data via ANOVA. Results: Forty-seven of 69 total dropouts participated. There was no difference in rate of dropout between modalities. A greater proportion of participants receiving in-person exposure therapy reported difficulties with logistical aspects of care (e.g., parking), whereas a greater proportion of participants receiving telemedicine therapy reported difficulty tolerating certain stressful aspects of treatment; however, those receiving telemedicine delivered treatment completed more sessions before dropping out. Participants in both conditions reported that they liked and were confident in their therapist Conclusions: Dropout reasons varied according to type of treatment delivery. Recommendations for future research are given in terms of modification of treatment protocol according to delivery modality.