Delivering Written Exposure Therapy for PTSD in Underserved Primary Care Settings

项目摘要 创伤后应激障碍（PTSD）在成年人中非常普遍，给社会造成了巨大的损失。 重要的是，在初级保健环境中PTSD的患病率甚至高于一般人群， 初级保健是PTSD患者最常出现的环境。循证 创伤后应激障碍的心理疗法（EBP）是可用的，但在真实的世界环境中的传播充满了 挑战，因为这些疗法需要10-15个，漫长的治疗疗程和广泛的治疗师培训 实施，这些治疗在初级保健环境中不可行，因为时间有限 资源因此，有多种障碍，以获得创伤后应激障碍的EBP。努力整合心理 通过协作护理管理（CoCM）干预， 迅速扩大，并已被证明是有效的治疗抑郁症和焦虑症。但是，在这方面， PTSD的证据是有限的，因为PTSD治疗方法的时间密集性， 被检查过了需要一种有效的创伤后应激障碍治疗方法来解决个人的治疗需求 出现创伤后应激障碍的病人书面暴露疗法（WET）是一种简短的EBP， 替代更密集的EBP。最近对WET的研究取得了积极的成果，并表明 直接与时间更密集的PTSD EBP相比，WET并不逊色，但WET还没有被证实。 在初级保健环境中进行检查。拟议研究的主要目的是评估 有效性和实施交付WET到CoCM，以改善PTSD的管理， 联邦合格卫生中心（FATHCs）中服务不足的初级保健患者。务实的集群- 随机化研究将使用混合有效性-实施设计。12名受试者将被随机分配至 CoCM + WET（CoCM+WET）或CoCM单独使用，每种COCM HC中将筛选60例患者， 资格。我们将使用RE-AIM框架（用于覆盖范围、功效/有效性、采用、实施和 维护），以评估CoCM+WET干预措施的有效性和实施过程， 混合方法。为了检查干预的有效性和潜在的调解人和主持人，我们将 在基线、3个月和6个月随访时进行评估。为了评估实施情况，我们将使用诊所 在干预前后处理数据和与诊所工作人员面谈。这项研究有可能大大提高 通过验证提供短暂创伤的有效性和可行性来影响实践和公共卫生- 在初级保健中将重点EBP嵌入CoCM中，以改善服务不足患者的PTSD结局。

PROJECT SUMMARY Posttraumatic stress disorder (PTSD) results in substantial costs to society is highly prevalent among adults. Importantly, the prevalence PTSD within primary care settings is even higher than the general population as primary care is the setting to which individuals with PTSD most often present. Evidence-based psychotherapies (EBPs) for PTSD are available but dissemination within real world settings is fraught with challenges because these therapies require 10-15, lengthy treatment sessions and extensive therapist training to implement, and these treatments are not feasible within primary care settings given the limited time resources. Consequently, there are multiple barriers to accessing EBPs for PTSD. Efforts to integrate mental health services within primary care for PTSD though collaborative care management (CoCM) interventions are rapidly expanding and have been shown to be effective in the treatment of depression and anxiety. However, the evidence for PTSD is limited due to the time intensive nature of the PTSD therapy approaches that have been examined. An efficient PTSD treatment approach is needed to address the treatment needs of individuals with PTSD presenting to primary care. Written exposure therapy (WET) is a brief EBP that provides an alternative to more intensive EBPs. Recent studies of WET have yielded positive outcomes and have shown it to be non-inferior when directly compared to more time intensive PTSD EBPs, but WET has not yet been examined within the primary care environment. The primary aims of the proposed study are to evaluate the effectiveness and implementation of delivering WET into CoCM to improve the management of PTSD among underserved primary care patients in Federally Qualified Health Centers (FQHCs). The pragmatic cluster- randomized study will use a hybrid effectiveness-implementation design. Twelve FQHCs will be randomized to either CoCM plus WET (CoCM+WET) or CoCM alone and 60 patients within each FQHC will be screened for eligibility. We will use the RE-AIM framework (for Reach, Efficacy/Effectiveness, Adoption, Implementation, & Maintenance) to evaluate the effectiveness and implementation process of the CoCM+WET intervention using mixed methods. To examine effectiveness and potential mediators and moderators of the intervention, we will administer assessments at baseline, 3- and 6-month follow-up. To assess implementation, we will use clinic process data and clinic staff interviews pre- and post-intervention. This study has the potential to substantially impact practice and public health by validating the effectiveness and feasibility of delivering a brief trauma- focused EBP embedded within CoCM in primary care to improve PTSD outcomes for underserved patients.