Primary Care For Trauma-related Mental Health Problems

创伤相关心理健康问题的初级保健

• 批准号: 7024583
• 负责人: Lisa Seidel Meredith
• 金额: $ 22.74万
• 依托单位: RAND CORPORATION
• 依托单位国家: 美国
• 财政年份: 2005
• 资助国家: 美国
• 起止时间: 2005-03-01 至 2008-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7024583
• 关键词: Hispanic Americans; adult human (21+); behavioral /social science research tag; clinical research; community health services; health care quality; health care referral /consultation; health care service evaluation; health disparity; health services research tag; human subject; immigrant; interview; low socioeconomic status; medically underserved population; mental disorder diagnosis; mental health services; patient care management; posttraumatic stress disorder; primary care physician

DESCRIPTION (provided by applicant): Patients with posttraumatic stress disorder (PTSD) and sub threshold PTSD present to primary care clinicians (PCCs) at rates similar to depression. The estimated lifetime prevalence of PTSD is 7.8% in the general population and is higher for underserved populations that are at greater risk for PTSD resulting from interpersonal, political, and community violence. Moreover, PTSD is poorly detected, under-treated, and debilitating. But, unlike the maturing field of depression in primary care with successful quality improvement interventions, little is known about effectively treating PTSD in this setting. We will employ a theory-based multi-level framework for guiding the first step in a program of research geared toward the development of primary care-based interventions for PTSD. We plan to follow with a full-scale effectiveness study application based on the results of this proposed work. We propose an exploratory study (R34) to better understand primary care trauma management and to identify promising strategies for improving the care of adult Latino immigrant patients suffering from PTSD and sub threshold PTSD. We will conduct this research in collaboration with the Clinical Directors Network, Inc. (CDN), a community-oriented practice-based research network that provides primary and preventive health care services for poor and underserved minority and immigrant populations. Specifically, we aim to:1. Describe primary care for PTSD and sub threshold PTSD from multiple stakeholder perspectives (medical directors, PCCs, and patients) among a sample of community/migrant health centers (C/MHCs) ranging in structural characteristics, and with a high proportion of Latino immigrant patients. 2. Identify structural and individual PCC predictors of PCC tendency to screen for, assess, refer, and manage PTSD and sub threshold PTSD. 3. Elucidate potential intervention strategies, based on data from Aims 1 and 2, to develop recommendations for viable strategies that could be tested in a follow-on study to improve primary care for PTSD and sub threshold PTSD. For Aim 1, we will conduct site visits and interviews with three types of key informants from a purposeful sample of five of the 57 C/MHCs that serve Latino immigrants and refugees in one CDN region that represent a range of clinical structures that might affect PTSD care (5 medical directors, 15 PCCs, and 4 patients with current PTSD matched to each of the 15 PCCs, N=60). For Aim 2, we will formally test hypotheses about predictors of variation in treatment for PTSD with a representative survey of a census of all 57 C/MHC directors and a random sample of 285 PCCs (5 per C/MHC). Aim 3 will use Aim 1 and 2 data and stakeholder meetings to identify potential interventions most likely to improve PTSD management and will culminate with a follow-on R01 application to implement and evaluate a promising intervention program for primary care-based treatment of PTSD and sub threshold PTSD in adult, Latino immigrants.

描述（由申请人提供）：患有创伤后应激障碍（PTSD）和亚阈值PTSD的患者以类似于抑郁症的比率向初级保健临床医生（PCC）提出。PTSD的估计终生患病率在一般人群中为7.8%，对于因人际、政治和社区暴力而导致PTSD风险更大的服务不足人群，PTSD的患病率更高。此外，PTSD检测不佳，治疗不足，使人衰弱。但是，与初级保健中成熟的抑郁症领域不同，成功的质量改善干预措施，在这种情况下有效治疗创伤后应激障碍知之甚少。我们将采用一个基于理论的多层次框架来指导研究计划的第一步，该计划旨在发展基于初级保健的PTSD干预措施。我们计划根据这项拟议工作的结果进行全面的有效性研究应用。我们提出了一项探索性研究（R34），以更好地了解初级保健创伤管理，并确定有前途的战略，以改善护理的成年拉丁美洲移民患者患有创伤后应激障碍和亚阈值创伤后应激障碍。我们将与临床总监网络公司合作开展这项研究。(CDN)这是一个以社区为导向、以实践为基础的研究网络，为贫困和服务不足的少数民族和移民人口提供初级和预防性卫生保健服务。具体而言，我们的目标是：1。从多个利益相关者的角度（医疗总监，PCC和患者）描述PTSD和亚阈值PTSD的初级保健社区/移民健康中心（C/MHCs）的样本中的结构特征，并与高比例的拉丁美洲移民患者。2.识别PCC倾向的结构和个体PCC预测因子，以筛查、评估、参考和管理PTSD和亚阈值PTSD。3.根据目标1和2的数据，阐明潜在的干预策略，以制定可行策略的建议，这些策略可以在后续研究中进行测试，以改善PTSD和亚阈值PTSD的初级保健。对于目标1，我们将进行现场访问和采访的三种类型的关键线人从一个CDN区域，代表一系列的临床结构，可能会影响创伤后应激障碍的护理（5个医疗主任，15个PCC，和4名患者与当前的创伤后应激障碍匹配的15个PCC，N=60）的57个C/MHC中的5个有目的的样本，为拉丁美洲移民和难民。对于目标2，我们将正式测试PTSD治疗变化预测因素的假设，对所有57名C/MHC主任进行普查，并随机抽取285名PCC（每个C/MHC 5名）。目标3将使用目标1和目标2的数据和利益相关者会议，以确定最有可能改善PTSD管理的潜在干预措施，并将以后续的R 01应用程序为高潮，以实施和评估一个有前途的干预计划，用于成年拉丁美洲移民的PTSD和亚阈值PTSD的初级保健治疗。

项目成果

System factors affect the recognition and management of posttraumatic stress disorder by primary care clinicians.

• DOI: 10.1097/mlr.0b013e318190db5d
• 发表时间: 2009-06-01
• 期刊: Medical care
• 影响因子: 3
• 作者: Meredith, Lisa S;Eisenman, David P;Tobin, Jonathan
• 通讯作者: Tobin, Jonathan