Design of the Violence and Stress Assessment (ViStA) study: a randomized controlled trial of care management for PTSD among predominantly Latino patients in safety net health centers.
Design of the Violence and Stress Assessment (ViStA) study: a randomized controlled trial of care management for PTSD among predominantly Latino patients in safety net health centers.
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DOI：
10.1016/j.cct.2014.04.005
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发表时间：
2014-07
影响因子：
2.2
通讯作者：
Tobin JN
中科院分区：
文献类型：
--
作者：
Meredith LS;Eisenman DP;Green BL;Kaltman S;Wong EC;Han B;Cassells A;Tobin JN
创伤后应激障碍（PTSD）是初级保健中的一个常见问题。虽然有有效的治疗方法，但在联邦合格医疗中心（FQHCs）的背景下，这些治疗方法是否有效，人们知之甚少，这些中心作为国家“安全网”，为低收入和保险不足的患者提供初级保健。暴力和压力评估（ViStA）研究是第一个随机对照试验（RCT），旨在测试护理管理干预对fqhc治疗PTSD的影响。为了开发一种适合低资源FQHC和他们服务的主要拉丁裔患者的PTSD管理干预措施，通过研究人员和FQHC基于实践的研究网络之间的合作进行了形成性工作。本文描述了如何召集FQHC利益相关者来审查、评估和优先考虑基于证据的策略，以解决患者、临床医生和系统层面的护理障碍。这种多成分护理管理干预包括诊断与反馈、患者教育和激活；导航和链接社区资源；临床医师教育和用药指导；以及结构化的跨学科沟通和护理的连续性，所有这些都由具有FQHC经验的护理经理促进。我们还描述了这项为期五年的随机对照试验的评估设计，以及404名参加研究的英语或西班牙语患者的特征，这些患者被随机分配到干预组或常规护理组。在基线、6个月和12个月时对患者进行评估，以检查对创伤后应激障碍、其他精神健康症状、与健康相关的生活质量、卫生保健服务使用的干预效果；以及对护理的感知障碍和对护理的满意度。
Posttraumatic stress disorder (PTSD) is a common problem in primary care. Although effective treatments are available, little is known about whether such treatments are effective within the context of Federally Qualified Health Centers (FQHCs) that serve as national “safety nets” for providing primary care for low income and underinsured patients. The Violence and Stress Assessment (ViStA) study is the first randomized controlled trial (RCT) to test the impact of a care management intervention for treating PTSD in FQHCs. To develop a PTSD management intervention appropriate for lower resource FQHCs and the predominantly Latino patients they serve, formative work was conducted through a collaborative effort between researchers and an FQHC practice-based research network. This article describes how FQHC stakeholders were convened to review, assess, and prioritize evidence-based strategies for addressing patient, clinician, and system-level barriers to care. This multi-component care management intervention incorporates diagnosis with feedback, patient education and activation; navigation and linkage to community resources; clinician education and medication guidance; and structured cross-disciplinary communication and continuity of care, all facilitated by care managers with FQHC experience. We also describe the evaluation design of this five-year RCT and the characteristics of the 404 English or Spanish speaking patients enrolled in the study and randomized to either the intervention or to usual care. Patients are assessed at baseline, six months, and 12 months to examine intervention effectiveness on PTSD, other mental health symptoms, health-related quality-of-life, health care service use; and perceived barriers to care and satisfaction with care.
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