From Training to Practice: Understanding the Integration of Evidence-Based Psychotherapies for Depression (INTEGRATE)

从培训到实践：了解抑郁症循证心理治疗的整合（INTEGRATE）

• 批准号: 10415725
• 负责人: Princess E. Ackland
• 金额: --
• 依托单位: MINNEAPOLIS VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2022
• 资助国家: 美国
• 起止时间: 2022-08-01 至 2026-02-28
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10415725
• 关键词: Address; Adjustment Disorders; Attitude; Caring; Classification; Clinic; Clinical Practice Guideline; Cognitive Therapy; Competence; Consultations; Data; Depressed mood; Depressive disorder; Development; Economic Burden; Effectiveness; Evaluation; Feeling suicidal; Goals; Guidelines; Health system; Intervention; Interview; Investigation; Leadership; Level of Evidence; Major Depressive Disorder; Medical center; Mental Depression; Mental Health; Mental Health Services; Mental disorders; Methodology; Methods; Modeling; Occupational; Patients; Perception; Policies; Post-Traumatic Stress Disorders; Process; Program Evaluation; Provider; Psychotherapy; Quality of life; Recurrence; Research; Resources; Risk Factors; Schedule; Site; Sleep Disorders; Specific qualifier value; Structure; Substance abuse problem; Suicide; Suicide prevention; System; Time; Training; Training Programs; Translations; Veterans; Visual; administrative database; burden of illness; care delivery; chronic pain; clinical implementation; design; evidence base; experience; innovation; interpersonal therapy; intervention mapping; medical specialties; multiple data sources; physical conditioning; provider-level barriers; reducing suicide; statistics; theories

Background. Depression is a highly prevalent mental health disorder that carries a heavy disease burden and is the 2nd leading risk factor for suicide among Veterans. VA has disseminated three effective psychotherapies for depression to VA clinics but therapist use of these treatments is <12%. Surprisingly, no studies have examined the provision of evidence-based psychotherapies for depression (D-EBPs) in VA and reasons underlying infrequent delivery, leaving a critical gap in depression care delivery in VA. System factors are a known driver of EBP use, and early signs from OMHSP's efforts and unique factors related to how depression care is organized in VA warrant an empirical investigation. Significance. Low utilization of D-EBPs and the lack of empirical evidence on barriers is a significant problem for several reasons. First, suicide prevention is a top priority in VA and across the nation and untreated depression is a major risk factor for suicide. Second, effectiveness of existing interventions that target provider-level barriers cannot be maximized without data about system barriers. Increasing the reach of other EBPs (e.g., PTSD) has required intervention at all levels (patient, provider, and system) and the same is undoubtably true for D-EBPs. Identifying and targeting system factors and exploring therapist factors and conducting the first exploration of patient perceptions of D-EBPs will bolster these early provider-focused interventions. Furthermore, this proposal is timely in that it comes on the heels of OMHSP's shift from assessing anticipated barriers to D-EBP delivery during trainings to developing partnerships to understand barriers experienced in the field. Finally, since this proposal is examining D-EBP delivery in specialty mental health clinics where other mental health conditions are treated, findings have implications of EBPs for those other conditions. Innovation/Impact. The proposed 3.5-year study will be the first study to examine reasons for low utilization of depression EBPs by therapists in VA. Our mixed-methods approach will yield a robust understanding of how the policies, resources and culture within specialty mental health clinics contribute to low D-EBP use by therapists. Our aims are directly aligned with OMHSP's goal to increase the implementation of clinical practice guideline-concordant care in VA mental health clinics. Our proposed classification of all VA medical centers on system-level factors that are associated with D-EBP delivery, strategic qualitative analysis, intervention mapping and stakeholder engagement provides invaluable data to OMHSP and the field quickly. Aims. 1) Quantitatively examine the association between health system factors and D-EBP delivery; 2) Qualitatively examine how contextual and system factors impact therapist decisions around the provision of D-EBPs; 3) Develop a framework of intervention targets and potential solutions to reduce barriers to D-EBP use; 4) Secondary/Exploratory Aims: a) Qualitatively explore how therapist factors impact D-EBP use; b) Explore patients' perceptions of D-EBPs. Methodology. Using an explanatory sequential mixed-method design, in Aim 1 (quantitative) we will abstract system-level and EBP training data for FY21 Q3-FY22 Q2. Descriptive statistics of system-level factors and general linear mixed model analysis will be used to characterize facilities and examine associations between system factors and therapists' D-EBP use. This will enable us to quickly understand both the main correlates of D-EBP utilization and variability of these factors across sites, provide critical data to our OMHSP partners and inform selection of sites for Aim 2. Aim 2 and secondary aims (qualitative) will include interviews with therapists trained in the three D-EBPs and mental health leaders from 10 VA medical centers (5 high and 5 low performers; N = 120- 150) and 20 patients to understand their perceptions of D-EBPs. Aim 3 will involve intervention mapping and Delphi strategies to develop a framework for reducing system barriers to D-EBP delivery. Implementation. Findings from our intervention framework development and strong partnership with OMHSP will maximize the translation of study findings into practice.

背景资料。抑郁症是一种非常普遍的精神健康疾病，它会带来沉重的疾病负担和 是退伍军人自杀的第二大危险因素。退伍军人管理局已经传播了三种有效的心理疗法 对于退伍军人事务部诊所的抑郁症，但治疗师使用这些治疗方法的比例为12%。令人惊讶的是，没有研究表明 审查了退伍军人事务部提供的循证抑郁症心理疗法(D-EBP)及其原因 潜在的不频繁的分娩，在退伍军人事务部的抑郁症护理提供方面留下了一个严重的缺口。系统因素是 已知的EBP使用的驱动因素，以及OMHSP努力的早期迹象和与抑郁症相关的独特因素 退伍军人事务部组织的护理需要进行实证研究。意义重大。D-EBPS的低利用率和 缺乏关于壁垒的经验证据是一个重大问题，原因有几个。首先，预防自杀是一种 退伍军人事务部和全国各地的首要任务是未经治疗的抑郁症是自杀的主要风险因素。第二, 如果没有数据，针对提供者层面障碍的现有干预措施的有效性就无法最大化 关于制度障碍。增加其他EBPS(例如，创伤后应激障碍)的影响需要各级的干预 (患者、提供者和系统)，D-EBPS无疑也是如此。识别和定位系统 因素和探索治疗师因素，并首次探索患者对D-EBPS遗嘱的认知 支持这些早期以提供者为重点的干预措施。此外，这项建议是及时的，因为它出现在 OMHSP从评估预期障碍转向在培训期间提供D-EBP 伙伴关系，以了解在该领域中遇到的障碍。最后，由于这项提案正在审查D-EBP 在治疗其他精神健康疾病的专业精神卫生诊所分娩，研究结果 EBPS对这些其他条件的影响。创新/影响。拟议的为期3.5年的研究将是 第一项研究旨在探讨退伍军人管理局治疗师对抑郁症EBPS使用率低的原因。我们的混合方法 方法将产生对专业内的政策、资源和文化如何在心理上 健康诊所有助于治疗师较低的D-EBP使用率。我们的目标与OMHSP的目标直接一致 加大退伍军人精神卫生门诊临床实践指南一致性护理的实施力度。我们的 建议根据与D-EBP相关的系统一级因素对所有退伍军人医疗中心进行分类 交付、战略定性分析、干预规划和利益相关者参与提供了无价的 快速将数据发送到OMHSP和现场。目标。1)定量检查卫生系统之间的关联 因素与D-EBP的传递；2)定性检查背景因素和系统因素如何影响治疗师 围绕提供D-EBP的决定；3)制定干预目标和潜力的框架 减少D-EBP使用障碍的解决方案；4)次要/探索性目标：a)定性探讨如何 治疗师因素影响D-EBP的使用；b)探讨患者对D-EBP的认知。方法论。使用 解释性顺序混合方法设计，在目标1(定量)中，我们将抽象系统级和EBP 21财年第三季度至22财年第二季度的培训数据。系统级因素和一般线性混合的描述性统计 将使用模型分析来描述设施的特征并检查系统因素和 治疗师的D-EBP使用。这将使我们能够快速了解D-EBP利用率的两个主要相关因素 这些因素在各个站点的可变性，为我们的OMHSP合作伙伴提供关键数据，并为选择 目标2的网站。目标2和次要目标(定性)将包括与接受过 来自10个退伍军人医疗中心的3名D-EBP和精神健康负责人(5名高绩效人员和5名低绩效人员；N=120- 150名)和20名患者了解他们对D-EBPS的看法。目标3将涉及干预地图和 德尔福战略，开发一个框架，以减少D-EBP交付的系统障碍。实施。 我们的干预框架开发和与OMHSP的强大合作伙伴关系的结果将使 将研究成果转化为实践。