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Effectiveness and Implementation of Brief Cognitive-Behavioral Therapy for Health Anxiety in Primary Care

初级保健中健康焦虑的简短认知行为疗法的有效性和实施

基本信息

批准号：
10256013
负责人：
Robert Edwin Brady
金额：
$ 13.89万
依托单位：
DARTMOUTH-HITCHCOCK CLINIC
依托单位国家：
美国
项目类别：
财政年份：
2018
资助国家：
美国
起止时间：
2018-09-28 至 2022-12-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/10256013
关键词：
Address Administrator Anxiety Anxiety Disorders Caring Chronic Disease Clinical Clinical effectiveness Cluster randomized trial Cognitive Therapy Communities Consolidated Framework for Implementation Research DSM-V Data Data Analyses Development Development Plans Disease Effectiveness Effectiveness of Interventions Emotional Enrollment Ensure Equipment and supply inventories Evaluation Evidence based practice Evidence based treatment Expenditure Experimental Designs General Population Geographic Locations Goals Health Health Services Accessibility Health behavior Hybrids Intervention Interview Lead Measures Medical Medical Care Team Mental Health Mentored Patient-Oriented Research Career Development Award Mentors Methods Monitor Outcome Outpatients Participant Patient Care Patient Self-Report Patient-Focused Outcomes Patients Pilot Projects Population Prevalence Primary Health Care Process Psychologist Research Research Personnel Research Project Grants Research Proposals Resolution Science Scientist Severities Single-Blind Study Symptoms System Technology Testing Training Treatment outcome anxiety-related disorders anxious arm care providers career career development clinical practice cognitive testing cost design effectiveness clinical trial effectiveness implementation study effectiveness implementation trial effectiveness testing effectiveness trial experience follow up assessment follow-up formative assessment health care settings implementation barriers implementation facilitators implementation intervention implementation science implementation strategy implementation trial improved novel patient engagement practice setting practice-based research network primary care setting psychosocial randomized controlled design recruit routine practice screening service utilization skill acquisition skills success therapy development treatment arm treatment as usual

项目摘要

PROJECT SUMMARY This application for a Mentored Patient-Oriented Research Career Development Award (K23) is designed to provide the applicant with the training needed to propel him into a productive career as an implementation scientist focused on overcoming the barriers that limit access to effective psychosocial interventions for anxiety and related disorders. The applicant is a clinical psychologist with existing skills in large data analyses and experimental design, and an emerging proficiency in the identification and resolution of impediments to access to care. The career development plan is mentored by experts in intervention development, evaluation, and implementation, who are dedicated to ensuring that the applicant gains expertise in 1) clinical effectiveness trials methods, 2) implementation science, and 3) team science to test optimal implementation strategies in a psychiatrically ill population. These advanced skill domains will be critical to his success as an independent investigator. Developing as an independent investigator with expertise in these methods will improve the delivery of cognitive-behavioral interventions by identifying and eliminating barriers to implementation of evidence-based practices. Cognitive-behavioral therapy has gained an unprecedented level of empirical support over the past five decades. Despite success in developing and testing cognitive-behavioral therapy, the dissemination of cognitive-behavioral therapy into healthcare settings has not matched empirical support and enthusiasm from the scientific community. The application of cognitive behavioral therapy as a technology in the treatment of disorders of health anxiety is further complicated by features of these disorders that lead to rejection and under-engagement with treatment. This complexity provides an opportunity to harness implementation science to develop more effective strategies to deliver evidence-based practices to the population. The applicant has developed a detailed research project that matches the research objectives to the career development skill domains. The research proposal consists of a 1) hybrid effectiveness-implementation trial to evaluate the feasibility, acceptability, and preliminary effectiveness of brief CBT for health anxiety delivered in primary care by MAs on patient engagement and patient outcomes, 2) developmental formative evaluation to further identify facilitators and barriers to implementation of the intervention in routine practice using qualitative interviews with clinical practice staff, and 3) pilot of the implementation strategy in a practice setting after modifying the intervention to address barriers and utilize facilitators. A planned follow-up trial will provide an opportunity to demonstrate the applicant's expertise in effectiveness trial methods, implementation science, and team science, as he builds a scientific team capable of conducting a cluster-randomized trial of the implementation strategy piloted in this project.

项目总结这份以患者为导向的导师研究职业发展奖(K23)申请书旨在为申请人提供所需的培训，以推动他作为实施人员进入富有成效的职业生涯科学家专注于克服限制获得有效的焦虑心理社会干预的障碍以及相关的疾病。申请人是一名临床心理学家，具备大数据分析和实验设计，以及在识别和解决准入障碍方面的新兴熟练程度去关心。职业发展计划由干预发展、评估和培训方面的专家指导实施，致力于确保申请者获得1)临床有效性方面的专业知识试验方法，2)实施科学，以及3)团队科学，以测试有精神疾病的人群。这些高级技能领域将是他作为一个独立人士取得成功的关键调查员。发展成为一名拥有这些方法专业知识的独立调查员将改善通过确定和消除实施以下各项的障碍来提供认知行为干预循证实践。认知行为疗法在过去的五年中获得了前所未有的经验支持。几十年。尽管在开发和测试认知行为疗法方面取得了成功，但认知行为疗法在医疗保健环境中的应用并不能与来自科学界。认知行为疗法作为一种技术在精神分裂症治疗中的应用健康焦虑的障碍由于这些障碍的特征而进一步复杂化，这些障碍会导致排斥和对治疗的投入不足。这种复杂性为利用实施科学提供了机会制定更有效的战略，向民众提供循证做法。申请人已经制定了一项详细的研究项目，使研究目标与职业相匹配。发展技能领域。研究建议包括1)混合有效性-实施试验，以评估简明CBT治疗健康焦虑的可行性、可接受性和初步有效性 MAS对患者敬业度和患者结局的初级护理，2)发展形成性评估进一步确定日常实践中实施干预的促进者和障碍，使用定性的与临床实践人员的面谈，以及3)在实践环境中进行实施战略的试点修改干预措施，以解决障碍和利用促进者。计划中的后续试验将提供有机会展示申请人在有效性试验方法、实施科学、和团队科学，因为他建立了一个科学团队，能够进行集群随机试验在该项目中试行的实施战略。