VA Healthcare Delivery for OEF/OIF Veterans with Mental & Substance Use Disorders

描述(由申请人提供)： 背景：关于持久自由行动/伊拉克自由行动/新黎明行动(OEF/OIF/OND)的心理健康研究强调，在VHA护理中的退伍军人中，创伤后应激障碍(PTSD)在这一重要人群中的高患病率。尽管VHA提供高质量、循证的创伤后应激障碍治疗，并且对于帮助治愈患有创伤后应激障碍的OEF/OIF/OND退伍军人和避免慢性的可能性是必要的，但在患有创伤后应激障碍的患者中，寻求和利用心理健康治疗的比例极低。对于患有创伤后应激障碍的OEF/OIF/OND退伍军人来说，每年的VHA强制性创伤后应激障碍筛查计划可能是一个重要的早期识别和治疗接入点，这些人没有积极寻求治疗他们的创伤后应激障碍症状。然而，通过筛查程序确定患有创伤后应激障碍的OEF/OIF/OND患者中与及时开始和参与治疗相关的因素尚未完成。还需要进一步研究，以确定可能的方法，以增加所有患有创伤后应激障碍的OEF/OIF/OND退伍军人的及时治疗启动和参与，测试旨在加强创伤后应激障碍治疗启动和参与的干预措施，并了解与最大限度地发挥已开发干预措施的潜在影响有关的执行问题。目的：本项目的目的是提供关键和及时的证据，以填补在VHA中患有创伤后应激障碍的OEF/OIF/OND退伍军人的治疗启动和参与方面的现有空白。建议的CDA-2研究的具体目的是：(1)在所有接受创伤后应激障碍筛查阳性并在初级保健中被诊断为创伤后应激障碍的VHA护理的OEF/OIF/OND退伍军人中，确定与及时启动和继续参与治疗相关的患者和提供者因素；(2)通过与提供者和OEF/OIF/OND退伍军人焦点小组的定性方法，进一步阐明与及时开始和继续参与PTSD治疗相关的患者因素；(

DESCRIPTION (provided by applicant): Background: Mental health research on Operation Enduring Freedom/Operation Iraqi Freedom/Operation New Dawn (OEF/OIF/OND) Veterans in VHA care highlights the high prevalence of posttraumatic stress disorder (PTSD) among this important population. Although high quality, evidence-based PTSD treatment is available in VHA, and is necessary to help heal these OEF/OIF/OND Veterans with PTSD and to avoid the possibility of chronicity, mental health treatment seeking and utilization is extremely low among those with PTSD. The yearly VHA mandatory PTSD screening program may be an important early identification and treatment access point for OEF/OIF/OND Veterans with PTSD who have not actively sought care for their PTSD symptoms. However, characterizing factors associated with timely treatment initiation and engagement among OEF/OIF/OND patients who are identified with PTSD via the screening program has not been accomplished. Further research is also needed to identify potential ways to increase timely treatment initiation and engagement for all OEF/OIF/OND Veterans with PTSD, to test interventions aimed at enhancing PTSD treatment initiation and engagement, and to understand implementation issues related to maximizing the potential impact of developed interventions. Objectives: The purpose of this project is to provide critical and timely evidence to fill in the existing gaps regarding treatment initiation and engagement among OEF/OIF/OND Veterans with PTSD in VHA. The specific aims of the proposed CDA-2 research are: (1) to identify patient and provider factors associated with timely treatment initiation and continued engagement among all OEF/OIF/OND Veterans in VHA care who receive positive PTSD screens and are diagnosed with PTSD in primary care; (2) further elucidate patient factors associated with timely initiation and continued engagement in PTSD treatment using a qualitative approach with provider and OEF/OIF/OND Veteran patient focus groups; (