Web and Shared Decision Making for Reserve/National Guard Women's PTSD Care

预备役/国民警卫队妇女创伤后应激障碍 (PTSD) 护理的网络和共享决策

• 批准号: 8397441
• 负责人: Anne Sadler
• 金额: --
• 依托单位: IOWA CITY VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-05-01 至 2016-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8397441
• 关键词: Address; Adherence; Afghanistan; Caring; Case Manager; Cognitive; Commit; Communities; Diagnosis; Educational Intervention; Enrollment; Evaluation; Female; Focus Groups; Goals; Health; Health Services Accessibility; Health education; Healthcare; Improve Access; Internet; Intervention; Knowledge; Mediating; Mental Health; Mental Health Services; Military Personnel; Modeling; Nurses; Online Systems; Outcome; Participant; Patients; Perception; Phase; Population; Post-Traumatic Stress Disorders; Process; Professional counselor; Psychotherapy; Qualitative Methods; Quality of Care; Randomized; Recommendation; Reporting; Research; Research Personnel; Resources; Route; Self Management; Services; Severities; Surveys; Testing; Veterans; War; Woman; alternative treatment; arm; assault; base; care delivery; care seeking; combat; comparative efficacy; evidence base; experience; follow-up; improved; insight; male; member; novel strategies; outreach; physical conditioning; policy implication; population health; preference; satisfaction; sexual assault; shared decision making; social stigma; standard of care; success; web based interface; web interface; willingness

DESCRIPTION (provided by applicant): Women and OEF/OIF/OND Reserve/National Guard (RNG) war Veterans are among the fastest growing groups of new VA users. Although PTSD is highly prevalent in this group of Veterans, most choose not to seek care for a variety of reasons. Facilitating access to mental health (MH) services for RNG OEF/OIF/OND female Veterans with PTSD is challenging and requires new approaches to outreach. Such approaches are urgently needed to mediate the severity of post- deployment MH conditions, alleviate concerns over MH diagnoses, and interrupt the cycle of chronicity found in many with PTSD. This gap between need for and use of VA PTSD services suggests that further research is needed to understand specific barriers to VA MH care and VA PTSD evidence-based psychotherapy (EBP). A web-based interface tailored to consumer needs has the potential to promote active engagement by Veterans in their health care. Considering that OEF/OIF combat Veterans enrolled in VA care report a preference to seek readjustment services or information over the internet, such an approach may have important advantages for engaging this group. Furthermore, evidence indicates that when patients are educated about their physical health conditions and treatment alternatives, shared decision- making results in increased treatment participation, better adherence to treatment recommendations, and better health outcomes. Although highly promising, web-based and shared-decision making approaches to facilitating VA MH treatment utilization are in need of further study. In Phase 1 of the project, we will use qualitative methods to assess VA enrolled PTSD positive OEF/OIF/OND RNG female war Veterans' perceptions, preferences and barriers and facilitators to accessing VA MH services and EBP for PTSD. This information will be used to refine our existing web-based interface to better address these issues. Satisfaction with the revised interface will then be assessed. Phase 2 will focus on comparing the efficacy of two approaches to promoting VHA initiation. Participants who screen positive for PTSD on the web interface will be randomly assigned to: 1) Study concierge nurse case manager (NCM) facilitated shared decision making to assist with VA MH evaluation and treatment; or 2) existing outreach (current standard of care). Follow-up assessments will be conducted at 6 and 12 months to determine whether and where participants sought MH care (from both VA and non-VA resources). This study will provide valuable insights about this population's perceptions of VA MH services and of PTSD EBP, as well as their evolving use of VA and other community resources to address PTSD and other post-deployment MH needs. Furthermore, it will provide important information regarding the efficacy of relatively inexpensive and resource-sparing interventions that can be readily implemented within existing and emerging (e.g., Patient Alight Care Teams [PACT]) models of VA care delivery. While the proposed web interface and shared decision- making intervention are currently directed at RNG women Veterans post-deployment, there are clear implications for expansion to other populations and health/MH concerns, as well. Findings have important policy implications for several operational partners heavily invested in the improved access and delivery of evidence-based mental health care for Veterans with PTSD

描述（由申请人提供）： 妇女和OEF/OIF/OND预备役/国民警卫队（RNG）退伍军人是增长最快的新VA用户群体之一。虽然创伤后应激障碍在这群退伍军人中非常普遍，但大多数人出于各种原因选择不寻求护理。为RNG OEF/OIF/OND患有创伤后应激障碍的女性退伍军人提供心理健康（MH）服务具有挑战性，需要新的外展方法。迫切需要这样的方法来调解部署后MH状况的严重性，减轻对MH诊断的担忧，并中断在许多患有PTSD的人中发现的慢性循环。VA PTSD服务的需求和使用之间的差距表明，需要进一步的研究，以了解具体的障碍VA MH护理和VA PTSD循证心理治疗（EBP）。根据消费者需求量身定制的基于网络的界面有可能促进退伍军人积极参与他们的医疗保健。考虑到参加退伍军人事务部护理的OEF/OIF战斗退伍军人报告说，他们倾向于通过互联网寻求重新调整服务或信息，这种方法可能对吸引这一群体具有重要优势。此外，有证据表明，当患者了解他们的身体健康状况和治疗方案时，共同决策会增加治疗参与，更好地遵守治疗建议，以及更好的健康结果。虽然非常有前途，基于网络和共享决策的方法，以促进VA MH治疗的利用需要进一步研究。在该项目的第一阶段，我们将使用定性方法评估VA登记的PTSD阳性OEF/OIF/OND RNG女性退伍军人的看法，偏好和障碍，以及获得VA MH服务和EBP治疗PTSD的促进者。这些信息将用于改进我们现有的基于网络的界面，以更好地解决这些问题。然后将评估对修订后的界面的满意度。第2阶段将重点比较两种促进VHA启动的方法的疗效。在网络界面上筛选出PTSD阳性的参与者将被随机分配到：1）研究礼宾护士病例经理（NCM）促进共同决策，以协助VA MH评估和治疗;或2）现有的外展（现行标准护理）。将在6个月和12个月时进行随访评估，以确定参与者是否以及在何处寻求MH护理（从VA和非VA资源）。这项研究将提供有关这一人群的看法VA MH服务和创伤后应激障碍EBP，以及他们不断变化的使用VA和其他社区资源，以解决创伤后应激障碍和其他部署后MH的需求有价值的见解。此外，它还将提供关于相对廉价和节省资源的干预措施的功效的重要信息，这些干预措施可以在现有和新出现的领域内容易地实施（例如，患者Alight护理团队[PACT]）的VA护理提供模式。虽然拟议的网络界面和共享决策干预目前针对的是RNG女性退伍军人部署后，但对扩展到其他人群和健康/MH问题也有明显的影响。研究结果对几个业务合作伙伴具有重要的政策意义，这些合作伙伴大力投资于改善创伤后应激障碍退伍军人循证精神卫生保健的获得和提供