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Delivering Written Exposure Therapy for PTSD in Underserved Primary Care Settings

在服务不足的初级保健机构中为 PTSD 提供书面暴露疗法

基本信息

批准号：
10285538
负责人：
Lisa Seidel Meredith
金额：
$ 103.44万
依托单位：
RAND CORPORATION
依托单位国家：
美国
项目类别：
财政年份：
2021
资助国家：
美国
起止时间：
2021-09-13 至 2026-06-30
项目状态：
未结题

来源：
https://reporter.nih.gov/project-details/10285538
关键词：
Address Adoption Adult Affect Age Anxiety Assimilations Boston Caring Characteristics Clinic Clinical Cognitive Communities Consultations Data Effectiveness Eligibility Determination Environment Exhibits Extinction (Psychology)Eye Movements Federally Qualified Health Center Fright Gender General Population Geography Health Services Accessibility Individual Intervention Interview Literature Maintenance Mediating Mediator of activation protein Medical Medicare/Medicaid Mental Depression Mental Health Mental Health Services Methods Monitor Nature Neighborhood Health Center Onset of illness Outcome Participant Patient Care Patient-Focused Outcomes Patients Post-Traumatic Stress Disorders Prevalence Primary Health Care Process Productivity Provider Psychotherapy Public Health Quality of Care Randomized Randomized Controlled Trials Reach, Effectiveness, Adoption, Implementation, and Maintenance Research Resources Severities Societies Supervision Symptoms Therapeutic Intervention Time Training Trauma Treatment outcome Underserved Population Universities Work base behavioral health collaborative care comorbidity cost depressive symptoms desensitization design effectiveness evaluation effectiveness implementation design effectiveness implementation study effectiveness implementation trial effectiveness testing effectiveness validation evidence base follow-up implementation outcomes implementation process improved improved outcome medical schools post intervention primary care setting primary outcome safety net secondary outcome

项目摘要

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.

项目总结