Implementation of the CALM intervention for anxiety disorders: a qualitative study
Implementation of the CALM intervention for anxiety disorders: a qualitative study
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DOI：
10.1186/1748-5908-7-14
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发表时间：
2012-03-09
影响因子：
7.2
通讯作者：
Roy-Byrne, Peter
中科院分区：
文献类型：
--
作者：
Curran, Geoffrey M.;Sullivan, Greer;Roy-Byrne, Peter
背景资料：研究人员最近在美国17个初级保健诊所测试了焦虑症协作护理干预的有效性：协调焦虑学习和管理（CALM）（原文如此）。调查人员还进行了定性过程评价。主要研究问题如下：（1）实施CALM的促进因素/障碍是什么？(2)研究完成后，维持CALM的促进因素/障碍是什么？研究方法：与47名诊所工作人员（18名初级保健提供者，13名护士，8名诊所管理人员和8名诊所工作人员）和14名经过研究培训的焦虑临床专家（ACS）进行了关键线人访谈，他们协调了协作护理并提供了认知行为治疗。访谈是半结构化的，通过电话进行。数据进行了内容分析，逐行分析，导致主题的发展和完善。结果：各利益攸关方都出现了类似的主题。实施的重要促进因素包括实施“低负担”的观念，提供者对干预措施的满意度，以及提供者与ACS的频繁互动。实施的障碍包括变量供应商在心理健康方面的兴趣，在诊所兼职供应商的高利率，和高社会压力较低的社会经济地位的患者干扰依从性。关键的可持续性促进因素是，如果一家诊所已经纳入了对另一种疾病的协作护理，以及现场精神卫生工作人员的存在。可持续性的主要障碍是加勒比国家联盟的资金。结论：在有效性试验期间，CALM干预相对容易纳入，满意度普遍较高。许多实施和可持续性障碍可能会限制广泛采用的范围和影响。应在了解本研究中的ACS由研究提供和培训的情况下解释结果。未来的研究应该探索CALM和类似干预措施的吸收，而不需要有效性试验的帮助。
Background: Investigators recently tested the effectiveness of a collaborative-care intervention for anxiety disorders: Coordinated Anxiety Learning and Management(CALM) (sic)) in 17 primary care clinics around the United States. Investigators also conducted a qualitative process evaluation. Key research questions were as follows: (1) What were the facilitators/barriers to implementing CALM? (2) What were the facilitators/barriers to sustaining CALM after the study was completed? Methods: Key informant interviews were conducted with 47 clinic staff members (18 primary care providers, 13 nurses, 8 clinic administrators, and 8 clinic staff) and 14 study-trained anxiety clinical specialists (ACSs) who coordinated the collaborative care and provided cognitive behavioral therapy. The interviews were semistructured and conducted by phone. Data were content analyzed with line-by-line analyses leading to the development and refinement of themes. Results: Similar themes emerged across stakeholders. Important facilitators to implementation included the perception of "low burden" to implement, provider satisfaction with the intervention, and frequent provider interaction with ACSs. Barriers to implementation included variable provider interest in mental health, high rates of part-time providers in clinics, and high social stressors of lower socioeconomic-status patients interfering with adherence. Key sustainability facilitators were if a clinic had already incorporated collaborative care for another disorder and presence of onsite mental health staff. The main barrier to sustainability was funding for the ACS. Conclusions: The CALM intervention was relatively easy to incorporate during the effectiveness trial, and satisfaction was generally high. Numerous implementation and sustainability barriers could limit the reach and impact of widespread adoption. Findings should be interpreted with the knowledge that the ACSs in this study were provided and trained by the study. Future research should explore uptake of CALM and similar interventions without the aid of an effectiveness trial.