Reducing COVID-related PTSD symptoms in Frontline Healthcare Workers through Trauma-Focused Treatment in Employee Assistance Programs

项目概要/摘要 2019冠状病毒病疫情前线的医护人员正经历前所未有的水平 压力和创伤暴露，导致创伤后应激障碍的发病率异常高（27-57%） （PTSD）。尽管员工援助计划（EAP）已将其服务范围扩展到支持医疗保健， 由于在大流行期间没有足够的工作人员，他们缺乏为PTSD提供时间密集型一线治疗的能力。到 为了解决这个问题，研究小组将标准的一线12次治疗调整为简短的4-6次治疗， 会话格式（延长暴露于初级保健; PE-PC），并证明了其在军事服务的有效性 成员鉴于前线医护人员的创伤后应激障碍呈上升趋势，迫切需要测试 有效性，并随后通过利用现有资源为该人群实施PE-PC 医疗系统EAP。长期目标是解决与COVID-19相关的PTSD症状， 医护人员和其他弱势群体。本申请的总体目标是证明 有效性，并确定在医疗保健系统中实施PE-PC的障碍和促进因素 EAP。核心假设是，PE-PC将减少COVID-19相关的PTSD症状，并改善 功能，相比EAP治疗作为替代疗法（TAU）。基本原理是有效治疗COVID-19- EAP环境中的相关PTSD是一种可扩展且具有成本效益的方法，可以减少医护人员的痛苦， 残疾，并将为医疗保健组织及其患者带来下游利益。完成 目标，本项目将测试PE-PC的有效性，由EAP顾问通过远程医疗提供， 与密歇根州东南部四个医疗保健系统的360名患有PTSD的医护人员的EAP TAU相比。这 混合1型有效性-实施试验将测试PE-PC的有效性，并收集以下数据： 通过进程评价和执行情况摸底来执行。具体目标：具体目标 1：比较PE-PC与EAP TAU在6周时（治疗后）减少PTSD症状的有效性。 治疗）、3个月和6个月随访。具体目标2：比较PE-PC与EAP TAU的有效性 在6周、3个月和6个月的随访中，减少倦怠，改善工作表现和功能。 探索性目标1：确认机制，并确定关键的调解人/主持人。探索性目标2：行为 成本效益分析。探索性目标3：通过实施流程为未来实施做好准备 评估和实施规划。这一战略将产生一项执行战略， 解决具体执行环境行动方案的障碍。该项目意义重大，因为它将有助于该领域的发展， 为患有COVID-19相关PTSD的一线医务工作者提供即时干预，从而改善临床实践， 这一弱势群体以及加强对未来突发公共卫生事件的准备。这项建议是 创新，因为它将改变有效的创伤后应激障碍治疗，从传统的长期护理， 专科护理设置，以简短的治疗与远程保健选项在前线社区设置。

Project Summary/Abstract Healthcare workers on the frontlines of the COVID-19 pandemic are experiencing unprecedented levels of stress and trauma exposure, resulting in exceptionally high rates (27-57%) of posttraumatic stress disorder (PTSD). Although Employee Assistance Programs (EAPs) have expanded their offerings to support healthcare workers during the pandemic, they lack the capacity to provide time-intensive first-line treatments for PTSD. To address this problem, the study team has adapted a standard first-line 12-session treatment into a brief, 4-6 session format (Prolonged Exposure for Primary Care; PE-PC) and demonstrated its efficacy in military service members. Given the rising tide of PTSD in frontline healthcare workers, there is an urgent need to test the effectiveness and subsequently implement PE-PC for this population by leveraging the existing resource of the healthcare system EAP. The long-term goal is to address COVID-19-related PTSD symptoms among healthcare workers and other vulnerable populations. The overall objective of this application is to demonstrate the effectiveness and identify barriers and facilitators to the implementation of PE-PC in healthcare system EAPs. The central hypothesis is that PE-PC will reduce COVID-19-related PTSD symptoms and improve functioning, compared to EAP Treatment as Usual (TAU). The rationale is that effectively treating COVID-19- related PTSD in the EAP setting is a scalable and cost-effective way to reduce healthcare worker distress and disability and will accrue downstream benefits to the healthcare organization and its patients. To accomplish the objective, this project will test the effectiveness of PE-PC, delivered by EAP counselors via telehealth, versus EAP TAU in 360 healthcare workers with PTSD at four southeast Michigan healthcare systems. This Hybrid Type 1 effectiveness-implementation trial will test the effectiveness of PE-PC and gather data regarding implementation through process evaluation and implementation mapping. The specific aims are: Specific Aim 1: Compare the effectiveness of PE-PC versus EAP TAU in reducing PTSD symptoms at 6-week (post- treatment), 3-, and 6-month follow-ups. Specific Aim 2: Compare the effectiveness of PE-PC versus EAP TAU in reducing burnout and improving job performance and functioning at 6-week, 3-, and 6-month follow-ups. Exploratory Aim 1: Confirm the mechanism and identify key mediators/moderators. Exploratory Aim 2: Conduct cost-effectiveness analysis. Exploratory Aim 3: Prepare for future implementation by conducting process evaluation and implementation mapping. This strategy will yield an implementation strategy that is targeted to address EAP-specific implementation barriers. This project is significant because it will contribute to the field a point-of-care intervention for frontline HCWs with COVID-19 related PTSD, thus improving clinical practice for this vulnerable population and increasing preparedness for future public health emergencies. This proposal is innovative because it will it will shift delivery of efficacious PTSD treatment from lengthy care in a traditional specialty care setting to brief treatment with a telehealth option in a frontline community setting.