Improving Function Through Primary Care Treatment of PTSD

通过 PTSD 的初级保健治疗改善功能

• 批准号: 10685244
• 负责人: SHEILA A.M. RAUCH
• 金额: --
• 依托单位: VETERANS HEALTH ADMINISTRATION
• 依托单位国家: 美国
• 财政年份: 2018
• 资助国家: 美国
• 起止时间: 2018-10-01 至 2023-09-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/10685244
• 关键词: Address; Afghanistan; Aftercare; Behavior Therapy; Caring; Chronic Post Traumatic Stress Disorder; Clinic; Clinical; Clinical Practice Guideline; Clinical Research; Conflict (Psychology); Diagnosis; Effectiveness; Event; Evidence based treatment; Exclusion Criteria; Exposure to; Goals; Health; Health Personnel; Health Services Accessibility; Health Surveys; Individual; Infrastructure; Intention; Intervention; Iraq; Life; Measures; Medication Management; Mental Depression; Mental Health; Mental Health Services; Military Personnel; Modeling; Monitor; Motivation; Outcome; Patient Self-Report; Patients; Pharmaceutical Preparations; Pilot Projects; Post-Traumatic Stress Disorders; Primary Health Care; Probability; Protocols documentation; Psychotherapy; Quality of life; Questionnaires; Randomized; Randomized Clinical Trials; Randomized Controlled Trials; Recovery; Reporting; Research; Research Design; Research Personnel; Research Priority; Resources; Role; Services; Severities; Symptoms; Testing; Training; Translating; Treatment Protocols; Veterans; Work; World Health Organization Disability Assessment Schedule; attentional control; base; behavioral health; brief intervention; care seeking; combat; cost; diagnostic criteria; effective intervention; effective therapy; evidence base; experience; follow up assessment; follow-up; functional disability; functional outcomes; implementation strategy; improved; improved functioning; medical specialties; meetings; military treatment facility; primary outcome; recruit; seal; service member; standard of care; treatment as usual; treatment choice

Posttraumatic stress disorder (PTSD) is a debilitating and costly mental health issue (Greenberg, Sisitsky et al. 1999, Hoge, Terhakopian et al. 2007). RAND reported an estimated two-year cost of $4.0 to $6.2 billion US dollars for mental health issues from the current conflicts in Iraq and Afghanistan and further estimated that providing evidence-based treatments for PTSD and depression could save an estimated $86.2 million (Tanielian, et al. 2008). Even modest reductions in PTSD severity have been related to increased probability of positive function outcomes (Smith, et al. 2005). Prolonged Exposure (PE) therapy (Foa, et al. 2000, Foa, et al. 2005, Schnurr, et al. 2007) is an effective, first-line treatment for PTSD (IOM 2007, VA/DOD 2010). While highly effective, PE is provided in specialty mental health settings typically in 8 to 15, weekly 90 minute individual sessions. Veterans with PTSD are often reluctant to seek care in specialty mental health, and, as a result, many are treated solely in primary care and do not have access to this effective intervention (Possemato, et al. 2011). While the DoD and VA have actively integrated behavioral health providers into their primary care clinics (Maguen, et al. 2010, Seal, et al. 2011), current behavioral interventions for PTSD in primary care are often inconsistent with clinical practice guidelines and/or not effective (Possemato, et al. 2011). Since functional outcomes are critical, we intend to extend beyond assessing the impact of PE-PC on clinical outcomes to function. Thus, there is a clear and urgent need to further develop, validate, and disseminate evidence-based psychotherapeutic treatments for PTSD in integrated VHA PC-MHI with a focus on functional outcomes. To fill this need and gap in care the study investigators developed a Brief Prolonged Exposure for Primary Care (PE-PC) treatment protocol with 4, 30-minute sessions for use in a stepped care model. A pilot study in military treatment facilities found PE-PC resulted in reductions in PTSD that were maintained at 6- and 12-month follow-up (Cigrang, et al, 2015). Preliminary results from a randomized controlled trial (RCT; PI: Cigrang; CoI: Rauch) of PE-PC compared to minimal attention control (MAC, including continuation of any PC initiated treatment) found a significantly larger reduction in PTSD severity (measured by PCL) in PE-PC than MAC (between group d = .78, p = .01). The strength of these initial findings is limited by lack of functional outcomes and examination of impact in VHA. While Service Members and Veterans have many similarities, potential differences in motivation for treatment and other factors may influence the efficacy of the protocol especially when examining changes in function. The proposed study will randomize 120 Veterans at Ralph H. Johnson VAMC presenting in primary care with PTSD who meet minimal inclusion/exclusion criteria to 6 weeks of PE-PC or PC-MHI-treatment as usual (TAU). Recruitment will occur over 36 months. All Veterans will complete a baseline assessment prior to randomization and post- treatment follow-up assessments at Weeks 6, 12, and 24 post-randomization. Primary outcome will be function assessed as self-reported role function in several domains. In addition, we will examine symptoms severity and effectiveness, acceptability, and utilization associated with PE-PC or PCMHI-TAU in the 6 months prior to randomization and 6 months following treatment completion. PE-PC may allow access to effective treatment and efficient allocation of PTSD specialty treatment resources in the VHA. This topic is of key relevance to Veteran mental health care and can provide a new access point for high quality PTSD care to improve function allowing many more Veterans to experience improvement.

创伤后应激障碍（PTSD）是一种使人衰弱且代价高昂的精神健康问题（Greenberg, Sisitsky）

项目成果

Improving function through primary care treatment of PTSD: The IMPACT study protocol.

通过 PTSD 的初级保健治疗改善功能：IMPACT 研究方案。

• DOI: 10.1016/j.cct.2022.106881
• 发表时间: 2022
• 期刊: Contemporary clinical trials
• 影响因子: 2.2
• 作者: Rauch,SheilaAM;Kim,HMyra;Acierno,Ron;Ragin,Carly;Wangelin,Bethany;Blitch,Kimberly;Muzzy,Wendy;Hart,Stephanie;Zivin,Kara;Cigrang,Jeffrey
• 通讯作者: Cigrang,Jeffrey

Improving function through primary care treatment of posttraumatic stress disorder study outcomes: A randomized controlled trial of prolonged exposure for primary care in veterans.

通过创伤后应激障碍的初级保健治疗改善功能研究结果：一项针对退伍军人长期接受初级保健的随机对照试验。

• DOI: 10.1037/fsh0000823
• 发表时间: 2023
• 期刊: Families, systems & health : the journal of collaborative family healthcare
• 作者: Rauch,SheilaAM;Kim,HMyra;Acierno,Ron;Ragin,Carly;Wangelin,Bethany;Blitch,Kimberly;Muzzy,Wendy;Hart,Stephanie;Zivin,Kara
• 通讯作者: Zivin,Kara