Improving Communication Between Primary Care Providers and Their Trauma Patients

改善初级保健提供者与其创伤患者之间的沟通

• 批准号: 7873356
• 负责人: Bonnie L Green
• 金额: $ 30.12万
• 依托单位: GEORGETOWN UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-07-01 至 2011-08-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7873356
• 关键词: Address; Affect; Anxiety; Area; Attention; Behavior; Caring; Code; Communication; Communities; Complement; Control Groups; Controlled Study; Depressive disorder; Educational Curriculum; Educational process of instructing; Emotional; Evaluation; Goals; Growth; Healed; Healthcare Systems; Interpersonal Violence; Intervention; Investigation; Learning; Link; Low Income Population; Low income; Manuals; Medical; Mental Health; Minority; Modification; Morbidity - disease rate; Outcome; Patients; Preventive; Primary Health Care; Process; Provider; Randomized; Research; Risk; Self Assessment; Services; Simulate; Survivors; Testing; Training; Trauma; Visit; Vulnerable Populations; Waiting Lists; Work; abstracting; base; care systems; clinical research site; cost; experience; follow-up; healing; improved; primary care setting; primary outcome; programs; safety net; secondary outcome; skills; theories; trauma centers

Improving Communication between Primary Care Providers and their Trauma Patients Abstract Trauma, especially interpersonal violence, is associated with a variety of emotional complaints, anxiety and depressive disorders, and interpersonal problems, as well as increased medical morbidity, decreased preventive care, and increased costs to the health care system. Yet trauma-related problems have not received sufficient attention in training of providers or in primary care settings, and providers feel unprepared to work with these patients. The proposed research utilizes the R34 mechanism to adapt and pilot test a theory- based practical approach to working productively with trauma survivors, the Risking Connection curriculum, to be appropriate for primary care providers (PCPs) serving low-income and minority patients. The following aims are proposed: 1) To adapt an existing manual and training curriculum on working therapeutically with trauma survivors to be appropriate for primary care providers. Risking Connection (RC) is a theory-based practical approach to teaching service providers how to work with trauma survivors in a variety of settings, with a focus on growth-promoting and healing relationships. The process of adaptation includes multiple modifications informed by the expert team's experiences, extensive input of PCPs, and the vetting of the curriculum to patients. 2) To evaluate initial acceptability of the curriculum and associated materials. This aim includes the early piloting of the training curriculum with 16 PCPs, and qualitative investigations of its feasibility and acceptability. It also focuses on clarifying the theory-linked areas in which the curriculum is likely to affect provider behavior and patient evaluations and outcomes. 3) To implement a controlled study of the adapted training in PCPs in regional safety-net clinical sites. Four groups of eight PCPs each will be randomized to training or wait-list (delay) conditions; the waitlist groups will be trained after reassessment following delay. Outcomes will be assessed at baseline and after training for trained and control groups, and the delay group will be assessed again after training. The primary outcomes will consist of codes of independent raters, based on taped visits to the PCPs by standardized/simulated patients (SPs) in areas that link theoretically with the RC training. Secondary outcomes include acceptability and feasibility of the intervention to the providers, provider self-assessments of learned skills, ratings of the providers' skills by the SPs after their visit, ratings of a subset of the visits using discourse analysis, and the short-term impact on a subset of PCPs' actual patients. Follow-up of some providers for as long as 18 months will explore the extent of sustained gains in the target behaviors. The long-term goal of the research program is to support PCPs by providing them with multiple strategies to address the physical and mental health complaints of their patients, with follow-on research addressed to sustainability and patient outcomes. The research will complement other interventions that our Center for Trauma and the Community is developing for low-income patients, their providers, and the safety-net systems of care in which they are treated. Narrative The proposed research program aims to adapt and pilot test a curriculum for primary care providers (PCPs) to help them work more productively with trauma survivors. We plan to: (1) adapt an existing manual and training curriculum on working therapeutically with trauma survivors to be appropriate for PCPs, (2) evaluate initial acceptability of the curriculum and material to providers and patients; and (3) conduct a controlled study of the adapted training, all with a focus on providers serving low-income populations. Providing PCPs with multiple strategies to address the physical and mental health complaints of their patients will improve primary care for vulnerable populations.

改善初级保健提供者与创伤患者之间的沟通 摘要 创伤，特别是人际暴力，与各种情绪抱怨，焦虑和 抑郁症和人际关系问题，以及医疗发病率的增加， 预防保健，并增加了医疗保健系统的成本。然而，与创伤有关的问题并没有 在提供者培训或初级保健环境中得到足够的重视，提供者感到没有准备好 和这些病人一起工作。拟议的研究利用R34机制来适应和试点测试一个理论- 基于实践的方法，与创伤幸存者，风险连接课程， 适合为低收入和少数民族患者提供服务的初级保健提供者（PCP）。以下目标 建议：1）调整现有的手册和培训课程， 创伤幸存者适合初级保健提供者。风险连接（RC）是一种基于理论的 教学服务提供者如何在各种环境中与创伤幸存者合作的实用方法， 注重促进成长和治愈关系。适应过程包括多个 根据专家组的经验、PCP的广泛投入以及 给病人的课程2)评估课程和相关材料的初步可接受性。 这一目标包括对16名初级专业人员的培训课程进行早期试点，并对其进行定性调查。 可行性和可接受性。它还侧重于澄清理论相关领域的课程可能 以影响提供者的行为和患者的评价和结果。3)为了实施一项对照研究 在区域安全网临床站点进行适合的PCP培训。四组，每组八个PCP， 随机分配至培训或等待名单（延迟）条件;等待名单组将在重新评估后接受培训 延迟之后。将在基线和培训后评估培训组和对照组的结局， 延迟组将在培训后再次进行评估。主要结局将包括以下代码： 独立评分员，基于标准化/模拟患者（SP）在以下地区对PCP的录音访问， 理论上与RC训练相结合。次要结果包括可接受性和可行性， 对提供者的干预，提供者对所学技能的自我评估， 访问后的SP，使用话语分析的访问子集的评级，以及对一个短期的影响， PCP的实际患者的子集。对一些提供者长达18个月的随访将探索 目标行为的持续收益。该研究计划的长期目标是通过以下方式支持PCP 为他们提供多种策略，以解决他们的病人的身心健康投诉， 后续研究致力于可持续性和患者结局。该研究将补充其他 我们的创伤和社区中心正在为低收入患者开发的干预措施， 提供者，以及他们接受治疗的护理安全网系统。叙事 拟议的研究计划旨在调整和试点测试小学课程， 护理提供者（PCP）帮助他们更有效地与创伤幸存者一起工作。我们 计划：（1）调整现有的治疗工作手册和培训课程 与创伤幸存者适合PCP，（2）评估初始可接受性， 提供者和患者的课程和材料;（3）进行对照研究， 适应性培训，所有这些都侧重于为低收入人口服务的提供者。 为PCP提供多种策略，以解决身心健康问题 他们的病人的投诉将改善弱势群体的初级保健。