Primary Care For Trauma-related Mental Health Problems

描述（由申请人提供）：创伤后应激障碍（PTSD）和亚阈值PTSD患者出现在初级保健临床医生（PCCs）面前的比率与抑郁症相似。在一般人群中，PTSD的估计终生患病率为7.8%，而在服务不足的人群中，由于人际、政治和社区暴力，PTSD的风险更高。此外，创伤后应激障碍的发现不足，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，通过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项目的第一步，该项目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，并确定有希望的策略，以改善患有创伤后应激障碍和亚阈值创伤后应激障碍的成年拉丁裔移民患者的护理。我们将与临床主任网络公司（CDN）合作开展这项研究，这是一个面向社区的基于实践的研究网络，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保健服务。具体来说，我们的目标是：1。从社区/移民健康中心（C/MHCs）的结构特征和拉美裔移民患者比例较高的样本中，从多个利益相关者的角度（医疗主任、医疗保健公司和患者）描述创伤后应激障碍和亚阈值创伤后应激障碍的初级保健。2. 识别PCC的结构和个体预测因素，以筛查、评估、转诊和管理PTSD和亚阈值PTSD。3. 根据目标1和目标2的数据，阐明潜在的干预策略，以制定可行的策略建议，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。在目标1中，我们将对三种类型的关键信息提供者进行实地访问和访谈，这些信息提供者来自一个CDN地区57个为拉丁裔移民和难民服务的C/ mhc中的5个，这些C/ mhc代表了一系列可能影响PTSD护理的临床结构（5名医疗主任，15名PCCs和4名与15名PCCs相匹配的当前PTSD患者，N=60）。对于目标2，我们将通过对所有57名C/MHC主任的人口普查和285名PCCs（每个C/MHC 5名）的随机抽样进行代表性调查，正式检验关于创伤后应激障碍治疗变异预测因子的假设。目标3将使用目标1和目标2的数据和利益相关者会议来确定最有可能改善PTSD管理的潜在干预措施，并将以后续R01申请来实施和评估一个有前途的干预计划，用于成人，拉丁裔移民的创伤后应激障碍和亚阈值创伤后应激障碍的初级保健治疗。

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.