Patient Readiness for Improvement through Motivation, Engagement, and Decision-making for PTSD (PRIMED-PTSD)

患者准备好通过动机、参与和决策来改善 PTSD (PRIMED-PTSD)

• 批准号: 10259666
• 负责人: Jessica Ann Chen
• 金额: --
• 依托单位: VA PUGET SOUND HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-09-01 至 2025-08-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10259666
• 关键词: Address; Affect; Appointment; Belief; Benefits and Risks; Caring; Characteristics; Clinic; Clinical; Data; Decision Aid; Decision Making; Diagnosis; Education; Effectiveness; Emotional; Enrollment; Ensure; Ethnic Origin; Evidence based treatment; Familiarity; Feasibility Studies; Funding; Future; Gender; Goals; Growth; Health Personnel; Health Services Accessibility; Health Services Research; Healthcare; Hybrids; Intervention; Interview; Investments; Knowledge; Manuals; Measures; Mental Depression; Mental Health; Mental Health Services; Mentors; Mentorship; Methodology; Methods; Motivation; Outcome; Outpatients; Patient Care; Patient Preferences; Patients; Performance; Pharmaceutical Preparations; Post-Traumatic Stress Disorders; Primary Health Care; Procedures; Process; Protocols documentation; Provider; Psychologist; Psychotherapy; Race; Randomized; Readiness; Research; Research Activity; Research Methodology; Research Personnel; Research Priority; Research Support; Risk; Risk Factors; Role; Rural; Sampling; Self Efficacy; Services; Site; Suicide; Suicide prevention; Surveys; Testing; Time; Training; Training Activity; Trust; United States National Institutes of Health; Veterans; Visit; Woman; Work; acceptability and feasibility; base; career; clinical care; clinical practice; compliance behavior; design; effective therapy; effectiveness implementation trial; effectiveness testing; ethnic minority population; evidence base; evidence based guidelines; experience; feasibility trial; implementation barriers; implementation facilitators; implementation science; improved; innovation; medical specialties; patient oriented; patient-level barriers; pilot trial; preference; provider-level barriers; racial and ethnic; randomized trial; recruit; research to practice; rurality; shared decision making; telehealth; treatment as usual; treatment planning; user centered design

Background: Over 1 million Veterans have PTSD and most (80% or more) do not receive first-line treatments, evidence-based psychotherapies, despite significant VA investment to increase access to these treatments. Clinicians often struggle to engage Veterans in evidence-based psychotherapies because they can be emotionally challenging treatments. Engagement could be catalyzed by mental health providers integrated into primary care (i.e., VA’s Primary Care-Mental Health Integration, or PC-MHI) to maximize the reach of engagement efforts beyond specialty PTSD settings. Shared decision making, a process by which the patient and provider discuss treatment options, weigh benefits and risks, and select a treatment that meets the patient’s needs, addresses known patient and provider barriers to evidence-based psychotherapies, including knowledge, self-efficacy, and trust. However, no study has examined shared decision making for PTSD in primary care. The proposal will address this knowledge gap by developing and refining a shared decision making intervention for PTSD, Patient Readiness for Improvement through Motivation, Engagement, and Decision-making (PRIMED), using input from Veterans with diverse perspectives, PC-MHI providers, and VA operational partners to optimize integration of shared decision making into clinical care. We will collect acceptability and feasibility data to support an application for a future effectiveness-implementation trial. Significance/Impact: Dr. Chen’s proposed research addresses three HSR&D and VA priorities: 1) increase engagement and retention of Veterans in evidence-based PTSD treatments, 2) advance health services research methods, specifically implementation science and user-centered design, which focuses on thorough integration of Veteran and frontline provider input, and 3) support suicide prevention efforts through effective treatment of PTSD, a major risk factor for suicide. Innovation: The proposed project will promote significant change in current VA clinical practice. PC-MHI providers typically refer out patients with PTSD and defer discussions about treatment options to specialty providers. This proposal will help PC-MHI providers use a formal engagement strategy, shared decision making, to improve patients’ knowledge of first-line PTSD treatments and to build motivation for care. Specific Aims: 1) Refine PRIMED using user-centered design methods and diverse Veterans’ perspectives, 2) Beta test PRIMED in one rural and one urban PC-MHI clinic to optimize integration into clinical workflow and achieve satisfactory acceptability and feasibility across a range of settings, 3) Conduct a small, randomized pilot trial (N=40) of PRIMED vs. usual care in two VA PC-MHI clinics to assess the feasibility of study procedures, which will inform a future larger trial. Methodology: In Aim 1, Dr. Chen will conduct qualitative interviews using user-centered design methods with 25 VA PC-MHI patients with PTSD, oversampling women veterans and racial/ethnic minority veterans, to refine the PRIMED intervention protocol. In Aim 2, Dr. Chen will use rapid, iterative beta-testing with approximately 20 patients to optimize the acceptability and feasibility of delivering PRIMED in the clinical setting and its integration into clinical workflow across varied settings (small rural clinics and large urban clinics). In Aim 3, Dr. Chen will conduct a pilot randomized feasibility trial (N=40) to assess the feasibility of recruiting and randomizing Veterans and measuring treatment engagement and clinical outcomes. Next Steps/Implementation: The research and training activities will prepare the nominee to conduct a multi- site, hybrid type 1 effectiveness-implementation trial to test the effectiveness of PRIMED for increasing receipt of first-line PTSD treatments and to begin to assess implementation barriers and facilitators. Future work to move this research into practice would involve collaborating with operational partners to improve VA SAIL performance measures in mental health, which are weighted to encourage evidence-based psychotherapies.

背景：超过100万退伍军人患有创伤后应激障碍，大多数(80%或更多)没有接受一线治疗， 循证心理疗法，尽管退伍军人管理局为增加获得这些治疗的机会进行了大量投资。 临床医生经常很难让退伍军人参与循证心理治疗，因为他们可以 情感上的挑战治疗。参与可以通过将心理健康提供者整合到 初级保健(即退伍军人事务部的初级保健-精神卫生一体化，或PC-MHI)，以最大限度地扩大 超越专业创伤后应激障碍设置的参与努力。共同决策，患者通过这个过程 和提供者讨论治疗选项，权衡收益和风险，并选择符合 患者的需求，解决已知的患者和提供者对循证心理治疗的障碍，包括 知识、自我效能和信任。然而，还没有研究检查创伤后应激障碍的共同决策。 初级保健。该提案将通过制定和完善共同的决定来解决这一知识差距 对创伤后应激障碍进行干预，患者准备通过激励、参与和 决策(PRIMED)，使用来自不同视角的退伍军人、PC-MHI提供商和退伍军人管理局的意见 运营合作伙伴，以优化共享决策与临床护理的集成。我们会收集 可接受性和可行性数据，以支持未来有效性实施试验的申请。 意义/影响：陈博士提议的研究涉及三个HSR&D和VA优先事项：1)增加 退伍军人参与和保留循证创伤后应激障碍治疗，2)促进卫生服务 研究方法，特别是实施科学和以用户为中心的设计，注重彻底 整合退伍军人和一线提供者的意见，以及3)通过有效的 治疗创伤后应激障碍，这是自杀的主要危险因素。 创新：拟议的项目将推动当前VA临床实践的重大变化。PC-MHI 提供者通常会转介患有创伤后应激障碍的患者，并将有关治疗方案的讨论推迟到专科进行 供应商。该提案将帮助PC-MHI提供商使用正式的接洽策略、共享决策 提高患者对创伤后应激障碍一线治疗的知识，并建立护理动机。 具体目标：1)使用以用户为中心的设计方法和不同退伍军人的观点来完善Primed， 2)在一家农村和一家城市PC-MHI诊所启动Beta测试，以优化与临床工作流程的集成，并 在各种环境中实现令人满意的可接受性和可行性，3)进行小规模、随机的 在两家退伍军人管理局PC-MHI诊所进行预置护理与常规护理的试点试验(N=40)，以评估研究的可行性 程序，这将为未来更大的审判提供信息。 方法：在目标1中，陈博士将使用以用户为中心的设计方法进行定性访谈 25名患有创伤后应激障碍的VA PC-MHI患者，过度抽样女性退伍军人和种族/少数民族退伍军人，以完善 启动的干预方案。在目标2中，陈博士将使用快速、迭代的Beta测试，大约 20例患者优化临床环境下给予PRIMED的可接受性和可行性 整合到各种环境(小型乡村诊所和大型城市诊所)的临床工作流程中。在《目标3》中，Dr。 陈将进行试点随机可行性试验(N=40)，以评估招募和 对退伍军人进行随机化，并衡量治疗参与度和临床结果。 下一步/实施：研究和培训活动将为被提名者进行多项 现场，混合类型1有效性-实施试验以测试为增加接收而准备的有效性 评估创伤后应激障碍的一线治疗，并开始评估实施障碍和促进者。未来的工作是 将这项研究付诸实践将涉及与运营合作伙伴合作，以改善VA SAIL 心理健康方面的绩效衡量，加权以鼓励以证据为基础的心理治疗。