Delivering Written Exposure Therapy for PTSD in Underserved Primary Care Settings

项目总结 创伤后应激障碍(PTSD)给社会造成的巨大代价在成年人中非常普遍。 重要的是，初级保健环境中创伤后应激障碍的患病率甚至高于普通人群，因为 初级保健是创伤后应激障碍患者最常去的场所。循证的 治疗创伤后应激障碍的心理疗法(EBP)是可用的，但在现实世界中的传播充满了 挑战，因为这些疗法需要10-15次，漫长的治疗过程和广泛的治疗师培训 在有限的时间内，这些治疗在初级保健环境中是不可行的 资源。因此，获取创伤后应激障碍的循证医学计划存在多重障碍。努力整合心智 通过协作性护理管理(CoCM)干预，为创伤后应激障碍患者提供初级保健服务 迅速扩张，并已被证明在治疗抑郁和焦虑方面有效。然而， 关于创伤后应激障碍的证据是有限的，因为创伤后应激障碍的治疗方法具有时间密集性 被检查过了。需要一种有效的创伤后应激障碍治疗方法来满足个人的治疗需求 创伤后应激障碍被送到初级保健中心。书面暴露疗法(WEW)是一种简短的EBP，提供了一种 替代更密集的EBPS。最近对湿润环境的研究产生了积极的结果，并表明了这一点 与更多的时间密集型创伤后应激障碍EBPS相比，并不逊色，但湿还没有 在初级保健环境中进行检查。拟议研究的主要目的是评估 将湿气输送到CoCM以改善创伤后应激障碍管理的有效性和实施 联邦合格卫生中心(FQHC)的初级保健患者服务不足。语用集群-- 随机研究将使用混合有效性-实施设计。12家FQHC将被随机分配到 CoCM加湿(CoCM+湿)或单独使用CoCM，每个FQHC内的60名患者将接受筛查 资格。我们将使用RE-AIM框架(针对REACH、功效/有效性、采用、实施和 维护)以评估CoCM+湿干预的有效性和实施过程 混合方法。为了审查干预的有效性和潜在的调解人和调解人，我们将 在基线、3个月和6个月的随访时进行评估。为了评估实施情况，我们将使用诊所 处理干预前后的数据和诊所工作人员的访谈。这项研究有可能极大地 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健康- 在初级保健中嵌入CoCM的重点EBP，以改善服务不足患者的创伤后应激障碍结局。

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.