Prolonged Exposure (PE) for PTSD: Telemedicine vs. In Person

PTSD 的长期暴露 (PE)：远程医疗与面对面医疗

• 批准号: 8598427
• 负责人: Ronald E. Acierno
• 金额: --
• 依托单位: RALPH H JOHNSON VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2010
• 资助国家: 美国
• 起止时间: 2010-07-01 至 2014-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8598427
• 关键词: Address; Adopted; Aftercare; Area; Bypass; Caring; Client satisfaction; Clinic; Clinical; Country; Diagnosis; Diagnostic; Disease; Equipment; Evidence based practice; Experimental Designs; Face; Freedom; Future; Gender; Health; Health Care Costs; Health Services Accessibility; Healthcare; Home environment; Hospitals; Individual; Intervention; Iraq; Measures; Medical; Medical center; Mental Health; Mental Health Services; Mental disorders; Methods; Modality; Nature; Outcome; Persons; Phase; Post-Traumatic Stress Disorders; Primary Health Care; Process; Program Evaluation; Protocols documentation; Race; Randomized; Relative (related person); Risk; Rural; Services; Symptoms; System; Telemedicine; Testing; Training; Travel; Use Effectiveness; Veterans; War; Woman; base; clinical efficacy; cost; cost effective; cost effectiveness; design; economic outcome; effective therapy; effectiveness measure; experience; follow-up; innovation; interest; meetings; operation; outreach; prevent; programs; rural area; screening; social; social stigma; treatment center

ABSTRACT Project Background/Rationale: Approximately 15 to 17% of current Iraq war veterans meet full diagnostic criteria for MH problems such as post-traumatic stress disorder (PTSD) (Hoge et al., 2004). Prolonged Exposure (PE) is an empirically supported treatment for PTSD (Foa 1997; Schnurr et al., 2007), and has been adopted by the VAMC as one of the treatments of choice for the disorder, as evident by the VAMC-sponsored national training of clinicians to use PE. It is therefore important to employ treatment delivery methods that maximize the likelihood that all veterans in need, including veterans residing in rural settings, and veterans who avoid VAMC settings due to the stigma of receiving mental health treatment, will receive interventions such as PE. The May, 2005 Committee on Veterans Affairs, Subcommittee on Health has identified Telemedicine as a VA priority area to address this need. The present proposal is to study whether PE delivered via Telemedicine is as effective as PE delivered In Person. Telemedicine has been chosen for its ability to overcome what appear to be two major barriers to mental health care (Frueh et al., 2000): the difficulty that rural-residing veterans face in reaching VAMC facilities, and the stigma veterans perceive related to receiving mental health treatment. Indeed, if effective, PE delivered via telemedicine may address the problem inherent in the finding that 42% of those screening positive for PTSD indicate that they are interested in receiving help, but only 25% actually receive services (Hoge, et al., 2006). Project Objectives: Although effective treatments for PTSD exist and have been adopted by the VAMC, barriers to care of a social (e.g., stigma) and geographic (e.g., rural) nature prevent many veterans in need from receiving care. Telemedicine might address this need. The major objective of this study is to determine if PE delivered via Telemedicine is as effective as In Person PE in terms of (1) clinical; (2) process; and (3) economic outcomes. Project Methods: We propose to use a randomized between groups repeated measures (baseline, post- treatment, 3& 6-month followups) design with 226 OIF-OEF veterans diagnosed with PTSD to assess the relative effectiveness, measured in terms of symptoms, patient satisfaction, and costs, of PE delivered via Telemedicine vs. In Person formats. We hypothesize that no differences (i.e., non-inferiority) between the two formats will be evident in terms treatment gains, patient satisfaction, treatment attrition, patient satisfaction and direct healthcare costs. Anticipated Impacts on Veterans Healthcare: This study will provide important information regarding whether PE delivered via home-based Telemedicine equipment is as effective as traditional In Person delivery of PE for post-traumatic stress disorder. If shown to be as effective as In Person treatment, a new, innovative, and cost effective intervention delivery system for PTSD will have initial empirical support.

抽象的 项目背景/基本原理：当前伊拉克战争退伍军人的大约15％至17％会遇到完整的诊断 MH问题的标准，例如创伤后应激障碍（PTSD）（Hoge等，2004）。长时间 暴露（PE）是对PTSD的经验支持的治疗方法（FOA 1997； Schnurr等，2007），已经是 VAMC用作该疾病的首选治疗方法之一，这是由VAMC赞助的 全国临床医生使用PE的培训。因此，重要的是采用治疗方法 最大化所有有需要的退伍军人，包括居住在农村环境中的退伍军人和退伍军人 谁避免因接受心理健康治疗的污名而导致的VAMC设置，将接受干预 例如pe。 2005年5月，退伍军人事务委员会，卫生小组委员会已确定 远程医疗作为VA优先领域，以满足这一需求。目前的建议是研究PE是否 通过远程医疗交付的效果与亲自交付的PE一样有效。远程医疗已被选择 能够克服似乎是精神卫生保健的两个主要障碍的能力（Frueh等，2000）： 难以到达农村的退伍军人在达到VAMC设施方面面临的困难，而污名退伍军人感知到了 接受心理健康治疗。确实，如果有效，通过远程医疗交付的PE可以解决 在发现PTSD呈阳性的人中有42％的发现固有的问题表明他们有兴趣 在接收帮助时，但只有25％的人实际接受服务（Hoge等，2006）。 项目目标：尽管存在对PTSD的有效治疗，并已被VAMC采用，但 照顾社会（例如污名）和地理（例如，农村）的障碍，可以阻止许多有需要的退伍军人 从接受护理。远程医疗可能会满足这种需求。这项研究的主要目的是确定是否是否 通过远程医疗传递的PE在（1）临床方面与PE的亲自效果一样有效； （2）过程； （3） 经济成果。 项目方法：我们建议在组之间使用随机的重复度量（基线，之后的基线） 治疗，3和6个月的随访）设计，有226名OIF-OIF退伍军人被诊断为PTSD的设计 相对有效性，以症状，患者满意度和成本来衡量的PE通过 远程医疗与人身格式。我们假设两者之间没有差异（即非效率） 格式在治疗收益，患者满意度，治疗损耗，患者满意度和 直接医疗保健费用。 对退伍军人医疗保健的预期影响：这项研究将提供有关有关的重要信息 通过基于家庭的远程医疗设备交付的PE是否与传统的人交付一样有效 PE用于创伤后应激障碍。如果证明与个人治疗一样有效，一种新的，创新的， PTSD的经济有效干预输送系统将具有最初的经验支持。