Effectiveness and Implementation of Brief Cognitive Behavioral Therapy in CBOCs

CBOC 中简短认知行为疗法的有效性和实施

• 批准号: 9768337
• 负责人: Jeffrey Alexander Cully
• 金额: --
• 依托单位: MICHAEL E DEBAKEY VA MEDICAL CENTER
• 依托单位国家: 美国
• 财政年份: 2015
• 资助国家: 美国
• 起止时间: 2015-05-01 至 2019-04-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9768337
• 关键词: Address; Adoption; Aftercare; Ambulatory Care Facilities; Area; Beck depression inventory; Caring; Cities; Clinic; Clinical; Clinical Data; Clinical Trials; Clinical effectiveness; Cognitive Therapy; Collection; Communities; Computerized Medical Record; Data; Data Analyses; Depressed mood; Effectiveness; Evidence based treatment; Feedback; Future; Health; Health Personnel; Healthcare; Healthcare Systems; Homogeneously Staining Region; Hybrids; Individual; Intervention; Interview; Length; Logistics; Maintenance; Mental Depression; Mental Health; Mental Health Services; Methods; Modification; Needs Assessment; Oklahoma; Outcome; Participant; Patient Education; Patients; Persons; Policy Maker; Primary Health Care; Procedures; Provider; Psyche structure; Psychotherapy; Quality of life; Questionnaires; Randomized; Reaction; Research; Rural Health; Series; Service provision; Services; Specialist; Standardization; Structure; Surveys; System; Telephone; Testing; Therapeutic Intervention; Time; Training; Use Effectiveness; Veterans; Work; base; behavioral health; clinical implementation; clinical practice; contextual factors; depressive symptoms; design; evidence base; flexibility; follow-up; formative assessment; handbook; health administration; health care availability; implementation strategy; implementation trial; improved; multi-site trial; primary care services; primary care setting; primary outcome; recruit; response; tool; treatment as usual; treatment response; usual care arm

DESCRIPTION (provided by applicant): The proposed study will examine the clinical impact and implementation potential of a brief cognitive behavioral therapy (bCBT) for depressed Veterans treated in VA Community-Based Outpatient Clinics (CBOCs). The implications of this study are multifaceted and will provide: 1) clinical data on the effectiveness of bCBT for Veterans in CBOC settings; 2) training and clinical support to existing CBOC clinicians who currently struggle to incorporate evidence-based psychotherapies into their clinical practice; 3) a bCBT intervention that is highly flexible and holds the potential to reach Veterans who might otherwise go untreated; and 4) provide preliminary data on the impact of an implementation strategy to aid CBOC clinicians in the use of a structured bCBT. Depression is a serious health condition that places tremendous burden on patients and healthcare systems and is especially prevalent in Veterans. In 2008, the Veterans Health Administration released the Uniform Mental Health Services Handbook in an effort to expand the availability of mental health services for Veterans with depression, including expansion of services for primary care and CBOC settings. Although the VA remains a national leader in mental health services, the provision of psychotherapy within VA is limited, especially for Veterans cared for in CBOC settings. Currently, efforts are needed to assist CBOC clinicians and other stakeholders to address clinical effectiveness and practice barriers related to the utilization of evidence-based psychotherapy in CBOCs. Aim 1 will seek to determine whether depression outcomes differ as a function of the intervention (bCBT provided by CBOC clinicians vs. enhanced usual care) at post-treatment (4-month), and 8- and 12-month follow-up. Aim 2 will use a mixed-method formative evaluation to understand the contextual factors related to bCBT feasibility, adoption, and implementation. Formative evaluation will occur before, during, and after implementation and include a needs assessment, modifications to the clinical and implementation approaches, and collection and interpretation of data. The proposed 4-year multi-site trial seeks to use an effectiveness-implementation hybrid type 2 design to examine a bCBT intervention for Veterans with depression as delivered by existing mental health providers in VA CBOC clinics. Clinical effectiveness will focus on the use of a modular bCBT intervention for depression adapted from the PI's prior and ongoing work with Veterans in the primary care setting. A total of 232 Veterans with clinically elevated symptoms of depression will be recruited from CBOC clinics within the Houston and Oklahoma City VAMC stations (8 CBOCs per station). Eligible Veterans will be randomized to either bCBT or to an Enhanced Usual Care (EUC) arm where participant depression information will be conveyed to the Veteran through a depression tool kit as well as to VA providers through the electronic medical record. The proposed implementation strategy, informed by the PARHis framework and tested in an ongoing VA trial, will be vetted and modified through CBOC and national stakeholders. A comprehensive formative evaluation will seek to understand stakeholder needs, modify the proposed strategies (e.g. treatment materials, online clinician training, audit and feedback, and facilitation) and to assess implementation outcomes. As informed by the RE-AIM and PARHiS frameworks, the second aim will explore evidence, context, and facilitation of bCBT for CBOCs with outcomes related to feasibility, acceptability, and impact on care.

描述（由申请人提供）： 这项拟议的研究将探讨在VA社区门诊诊所（CBOCs）治疗抑郁症退伍军人的简短认知行为疗法（bCBT）的临床影响和实施潜力。这项研究的意义是多方面的，并将提供：1）bCBT在CBOC环境中对退伍军人有效性的临床数据; 2）培训和临床支持现有的CBOC临床医生，他们目前正在努力将循证心理治疗纳入他们的临床实践; 3）高度灵活的bCBT干预措施，并有可能达到退伍军人，否则可能无法治疗;和4）提供实施策略的影响的初步数据，以帮助CBOC临床医生使用结构化的bCBT。抑郁症是一种严重的健康状况，给患者和医疗保健系统带来巨大负担，在退伍军人中尤其普遍。2008年，退伍军人健康管理局发布了《统一精神卫生服务手册》，以扩大对患有抑郁症的退伍军人的精神卫生服务，包括 扩大初级保健和社区保健中心的服务。虽然退伍军人事务部仍然是全国精神卫生服务的领导者，但退伍军人事务部内提供的心理治疗有限，特别是对在CBOC环境中照顾的退伍军人。目前，需要努力帮助CBOC临床医生和其他利益相关者解决与CBOC中循证心理治疗的利用相关的临床有效性和实践障碍。目标1将试图确定抑郁症的结果是否因干预（由CBOC临床医生提供的bCBT与增强的常规护理）而在治疗后（4个月）以及8个月和12个月随访时有所不同。目标2将使用混合方法形成性评估，以了解与bCBT可行性，采用和实施相关的背景因素。形成性评价将在实施之前、期间和之后进行，包括需求评估、临床和实施方法的修改以及数据的收集和解释。拟议的4年多地点试验旨在使用有效性-实施混合2型设计来检查VA CBOC诊所现有心理健康提供者为患有抑郁症的退伍军人提供的bCBT干预。临床有效性将侧重于使用模块化bCBT干预抑郁症，根据PI先前和正在进行的与退伍军人在初级保健环境中的工作进行调整。将从休斯顿和俄克拉荷马州市VAMC站（每个站8个CBOC）内的CBOC诊所招募总共232名临床抑郁症状升高的退伍军人。符合条件的退伍军人将被随机分配到bCBT或增强型糖尿病护理（EUC）组，其中参与者的抑郁信息将通过抑郁工具包传达给退伍军人，并通过电子病历传达给VA提供者。拟议的实施战略以PARHis框架为依据，并在正在进行的VA试验中进行测试，将通过CBOC和国家利益攸关方进行审查和修改。全面的形成性评价将寻求了解利益相关者的需求，修改拟议的战略（例如治疗材料、在线临床医生培训、审计和反馈以及促进），并评估实施结果。正如RE-AIM和PARHiS框架所告知的，第二个目标将探索BCBT用于CBOC的证据、背景和促进作用，其结果与可行性、可接受性和对护理的影响有关。