Predictors of Initiation and Engagement of Cognitive Processing Therapy Among Veterans With PTSD Enrolled in Collaborative Care
Predictors of Initiation and Engagement of Cognitive Processing Therapy Among Veterans With PTSD Enrolled in Collaborative Care
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DOI：
10.1002/jts.22049
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发表时间：
2015-12-01
影响因子：
3.3
通讯作者：
Schnurr, Paula P.
中科院分区：
文献类型：
--
作者：
Grubbs, Kathleen M.;Fortney, John C.;Schnurr, Paula P.
协作护理（CC）增加了获得循证药物治疗和心理治疗的机会。本研究的目的是确定接受基于远程医疗的创伤后应激障碍（PTSD） CC干预的农村退伍军人的特征，这些退伍军人发起并参与了通过互动视频传递的认知加工治疗（CPT）。诊断为PTSD的退伍军人从11个社区门诊诊所招募（N = 133）。图表抽象确定了12个月研究期间收到的所有心理健康问题。一般线性混合模型用于识别预测CPT启动和参与（参加8次或更多会议）的特征。对于开始，根据临床医生管理的PTSD量表（d = -0.39, p = 0.038）较高的PTSD严重程度和选择退出招募（与自我转诊相比；d = -0.49, p = 0.010）是负面预测因素。就敬业度而言，重度抑郁（d = -1.32, p = 0.006）是负面预测因子，而待处理的兵役相关残疾索赔（d = 2.02, p = 0.008）是积极预测因子。一般来说，加入CC的退伍军人发起和参与CPT的比例高于常规护理。然而，那些有更严重症状和合并症的患者有不开始或不完成CPT的风险。
Collaborative care (CC) increases access to evidence-based pharmacotherapy and psychotherapy. The study aim was to identify the characteristics of rural veterans receiving a telemedicine-based CC intervention for posttraumatic stress disorder (PTSD) who initiated and engaged in cognitive processing therapy (CPT) delivered via interactive video. Veterans diagnosed with PTSD were recruited from 11 community-based outpatient clinics (N = 133).Chart abstraction identified all mental health encounters received during the 12-month study. General linear mixed models were used to identify characteristics that predicted CPT initiation and engagement (attendance at 8 or more sessions). For initiation, higher PTSD severity according to the Clinician Administered PTSD Scale (d = -0.39, p = .038) and opt-out recruitment (vs. self-referral; d = -0.49, p = .010) were negative predictors. For engagement, major depression (d = -1.32, p = .006) was a negative predictor whereas a pending claim for military service connected disability (d = 2.02, p = .008) was a positive predictor. In general, veterans enrolled in CC initiated and engaged in CPT at higher rates than usual care. Those with more severe symptoms and comorbidity, however, were at risk of not starting or completing CPT.