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: 7690239
• 负责人: Bonnie L Green
• 金额: $ 23.09万
• 依托单位: GEORGETOWN UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-09-23 至 2011-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7690239
• 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

DESCRIPTION (provided by applicant): 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. 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.

描述（由申请人提供）：改善初级保健提供者与其创伤患者之间的沟通 摘要 创伤，尤其是人际暴力，与各种情绪抱怨、焦虑和抑郁障碍、人际关系问题以及医疗发病率增加、预防性护理减少和医疗保健系统成本增加有关。然而，在提供者培训或初级保健机构中，与创伤相关的问题尚未得到足够的重视，并且提供者感觉没有准备好与这些患者一起工作。拟议的研究利用 R34 机制来调整和试点测试一种基于理论的实用方法，以与创伤幸存者进行富有成效的合作，即风险连接课程，以适合为低收入和少数族裔患者提供服务的初级保健提供者 (PCP)。提出以下目标： 1) 调整现有的创伤幸存者治疗手册和培训课程，使其适合初级保健提供者。风险联系（RC）是一种基于理论的实践方法，旨在教导服务提供者如何在各种环境中与创伤幸存者合作，重点是促进成长和治愈关系。适应过程包括根据专家团队的经验、PCP 的广泛投入以及针对患者的课程审核进行的多次修改。 2) 评估课程和相关材料的初步可接受性。这一目标包括与 16 名 PCP 一起早期试点培训课程，并对其可行性和可接受性进行定性调查。它还侧重于澄清课程可能影响提供者行为以及患者评估和结果的理论相关领域。 3) 对区域安全网临床中心的 PCP 适应性培训进行对照研究。四组，每组八名 PCP 将被随机分配到培训或等待名单（延迟）条件；候补名单上的群体将在延迟后重新评估后接受培训。将在基线和训练后对受训组和对照组的结果进行评估，延迟组将在训练后再次进行评估。主要结果将由独立评估者的代码组成，这些代码基于标准化/模拟患者 (SP) 在理论上与 RC 培训相关的领域对 PCP 的访问录音。次要结果包括提供者干预的可接受性和可行性、提供者对所学技能的自我评估、SP 在访问后对提供者技能的评级、使用话语分析对访问子集的评级，以及对 PCP 实际患者子集的短期影响。对一些提供者长达 18 个月的跟踪将探索目标行为持续收益的程度。该研究计划的长期目标是为 PCP 提供支持，为他们提供多种策略来解决患者的身心健康投诉，并针对可持续性和患者治疗结果进行后续研究。这项研究将补充我们的创伤和社区中心正在为低收入患者、他们的提供者以及他们接受治疗的安全网护理系统开发的其他干预措施。拟议的研究计划旨在调整和试点测试初级保健提供者（PCP）的课程，以帮助他们更有效地与创伤幸存者一起工作。我们计划：(1) 调整现有的创伤幸存者治疗手册和培训课程，使其适合 PCP，(2) 评估提供者和患者对课程和材料的初步可接受性； (3) 对适应性培训进行对照研究，重点关注为低收入人群提供服务的提供者。为 PCP 提供多种策略来解决患者的身心健康投诉，将改善弱势群体的初级保健。