Brief cognitive behavioral therapy in primary care: a hybrid type 2 patient-randomized effectiveness-implementation design.
Brief cognitive behavioral therapy in primary care: a hybrid type 2 patient-randomized effectiveness-implementation design.
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DOI：
10.1186/1748-5908-7-64
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发表时间：
2012-07-11
期刊：
影响因子：
--
通讯作者：
Kauth MR
中科院分区：
文献类型：
--
作者：
Cully JA;Armento ME;Mott J;Nadorff MR;Naik AD;Stanley MA;Sorocco KH;Kunik ME;Petersen NJ;Kauth MR
尽管抑郁症和焦虑症的循证心理疗法是可用的，但它们在初级保健等非心理健康专业环境中的使用不足。混合有效性实施设计有可能评估循证心理治疗的临床和实施结果，以提高其转化为常规临床护理实践。这篇研究方案文章讨论了一项正在进行的混合2型随机对照试验中采用的研究方法和实施策略，该试验有两个主要目的：（1）确定是否有案情摘要，由退伍军人事务部初级保健心理健康整合项目临床医生管理的手动认知行为疗法在治疗医学疾病样本中的抑郁和焦虑方面是有效的。（慢性心肺疾病）初级保健患者和（2）检查的可接受性，可行性，并在两个初级保健心理健康一体化诊所的重点实施战略，以提高采用和简短的认知行为治疗的保真度的初步结果。该研究采用混合型2有效性/实施设计，同时测试临床有效性，并收集多方面实施策略的试点数据，包括在线培训计划，会议内容的审计和反馈，以及内部和外部促进。此外，该研究还邀请了一个咨询理事会的参与，该委员会由初级保健与心理健康整合的利益相关者以及退伍军人管理局内的地区和国家心理健康领导人组成。它的目标是招募320名参与者，随机接受简短的认知行为治疗（n = 200）或常规护理（n = 120）。正在使用混合方法评估成效和执行成果，包括定量评价（例如，多个时间点的意向治疗分析）和定性方法（例如，从患者和提供者的焦点访谈和调查）。患者有效性结局包括使用盲法独立评价者测量抑郁、焦虑和身体健康功能。实施结果包括患者的参与度和依从性以及临床医生对认知行为疗法的采用和忠诚度。需要混合设计来提高临床有效性和实施知识，以改善医疗保健实践。目前的文章介绍了基本原理和挑战与使用的混合设计的研究，在初级保健的简短认知行为疗法。虽然科学控制和外部有效性之间存在权衡，但混合设计是一种新兴方法的一部分，有可能迅速推进科学和实践。http://www.clinicaltrials.gov/ct2/show/NCT01149772上的NCT 01149772
Despite the availability of evidence-based psychotherapies for depression and anxiety, they are underused in non-mental health specialty settings such as primary care. Hybrid effectiveness-implementation designs have the potential to evaluate clinical and implementation outcomes of evidence-based psychotherapies to improve their translation into routine clinical care practices. This protocol article discusses the study methodology and implementation strategies employed in an ongoing, hybrid, type 2 randomized controlled trial with two primary aims: (1) to determine whether a brief, manualized cognitive behavioral therapy administered by Veterans Affairs Primary Care Mental Health Integration program clinicians is effective in treating depression and anxiety in a sample of medically ill (chronic cardiopulmonary diseases) primary care patients and (2) to examine the acceptability, feasibility, and preliminary outcomes of a focused implementation strategy on improving adoption and fidelity of brief cognitive behavioral therapy at two Primary Care-Mental Health Integration clinics. The study uses a hybrid type 2 effectiveness/implementation design to simultaneously test clinical effectiveness and to collect pilot data on a multifaceted implementation strategy that includes an online training program, audit and feedback of session content, and internal and external facilitation. Additionally, the study engages the participation of an advisory council consisting of stakeholders from Primary Care-Mental Health Integration, as well as regional and national mental health leaders within the Veterans Administration. It targets recruitment of 320 participants randomized to brief cognitive behavioral therapy (n = 200) or usual care (n = 120). Both effectiveness and implementation outcomes are being assessed using mixed methods, including quantitative evaluation (e.g., intent-to-treat analyses across multiple time points) and qualitative methods (e.g., focus interviews and surveys from patients and providers). Patient-effectiveness outcomes include measures of depression, anxiety, and physical health functioning using blinded independent evaluators. Implementation outcomes include patient engagement and adherence and clinician brief cognitive behavioral therapy adoption and fidelity. Hybrid designs are needed to advance clinical effectiveness and implementation knowledge to improve healthcare practices. The current article describes the rationale and challenges associated with the use of a hybrid design for the study of brief cognitive behavioral therapy in primary care. Although trade-offs exist between scientific control and external validity, hybrid designs are part of an emerging approach that has the potential to rapidly advance both science and practice. NCT01149772 at http://www.clinicaltrials.gov/ct2/show/NCT01149772
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影响因子：
12.7
作者：
Glasgow, RE;Vogt, TM;Boles, SM
通讯作者：
Boles, SM
影响因子：
6.6
作者：
Gloaguen, V;Cottraux, J;Blackburn, IM
通讯作者：
Blackburn, IM
影响因子：
5.9
作者：
Cuijpers, Pim;van Straten, Annemieke;Andersson, Gerhard
通讯作者：
Andersson, Gerhard
DOI：
10.1007/s10880-011-9230-y
发表时间：
2011-03-01
影响因子：
2.2
作者：
Funderburk, Jennifer S.;Sugarman, Dawn E.;Nelson, Bruce
通讯作者：
Nelson, Bruce
影响因子：
10
作者：
GUYATT, GH;BERMAN, LB;CHAMBERS, LW
通讯作者：
CHAMBERS, LW