Improving PTSD Management in Primary Care

改善初级保健中的创伤后应激障碍 (PTSD) 管理

• 批准号: 7918879
• 负责人: Lisa Seidel Meredith
• 金额: $ 64.49万
• 依托单位: RAND CORPORATION
• 依托单位国家: 美国
• 财政年份: 2009
• 资助国家: 美国
• 起止时间: 2009-08-20 至 2014-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7918879
• 关键词: Address; Adoption; Anxiety; Caring; Case Manager; Clinical; Collaborations; Communities; Community Health Centers; Community Services; Complement; Continuity of Patient Care; Data; Data Analyses; Data Sources; Development; Direct Costs; Disease; Disease Management; Education; Effectiveness; Exposure to; Feedback; General Population; Goals; Guidelines; Hand; Health; Health Services; Health behavior; Healthcare; Immigrant; Intervention; Interview; Knowledge; Learning; Literature; Mediating; Mental Depression; Mental Health; Mental Health Services; Mental disorders; Methods; Modeling; National Institute of Mental Health; Outcome; Patient Education; Patients; Population; Population Intervention; Post-Traumatic Stress Disorders; Prevalence; Preventive; Primary Health Care; Process; Public Health; Randomized; Reporting; Research; Research Methodology; Research Project Grants; Resources; Safety; Screening procedure; Services; Specialist; Stigmata; Structure; Symptoms; System; Testing; Time; Trauma; Underrepresented Minority; Underserved Population; Violence; Wages; Work; Writing; base; community based participatory research; experience; health related quality of life; improved; interest; patient registry; practice-based research network; prevent; primary care setting; primary outcome; programs; psychologic; public health relevance; randomized trial; resource guides; satisfaction; social stigma; success; theories; treatment as usual

DESCRIPTION (provided by applicant): Post-traumatic stress disorder (PTSD) is common in the general population (9-17% lifetime prevalence; Bruce et al., 2001; Fifer et al., 1994; Gillock et al., 2005; Neria et al., 2006; Stein et al., 2000) and among primary care patients (up to 35%; Gillock et al., 2005). Most people with common mental health disorders do not seek treatment from mental health specialists (Kessler et al., 1994; 1995) but from primary care clinicians (PCCs). Despite the availability of treatments for PTSD, patient, clinician, and system barriers prevent most from receiving adequate care (Lecrubier, 2004; Samson et al, 1999; Stein et al., 2000; Stein 2003; Kessler, 2000; Jaycox et al., 2004). Therefore, approaches are needed to eliminate barriers and increase treatment opportunities for those suffering from PTSD. We address this gap by drawing upon the abundant work on improving primary care for depression (Wells et al., 2000, 2004; Rost et al., 2002; Dietrich et al., 2004; Rubenstein et al., 2006; Meredith et al., 2000, 2006) and from our exploratory/developmental work (R34MH070683) that used a community-based participatory research (CBPR) approach to identify viable strategies for overcoming barriers to providing and receiving care for PTSD. We propose a 5-year follow-on randomized trial to test the impact of a PTSD Care Management (PCM) program for patients seeking primary care from community health centers (CHCs). Our proposal addresses NIMH priorities for "understanding effective means of organizing, implementing, financing, and delivering mental health services in primary care" outlined in PA-07-312 "Mental Health Consequences of Violence and Trauma (R01)". We will randomize 400 patients from six CHCs to either the PCM intervention (N=200) or to a control condition (N=200). The intervention includes components and strategies implemented through a Care Manager (CM): 1) patient education, 2) patient screening and feedback to PCCs, 3) clinician education and use of guidelines, 4) structured feedback between primary care and mental health clinicians, 5) continuity of patient care, and 6) a resource guide detailing available community services. The control condition includes only the clinician education and patient screening without feedback. Specifically, we aim to: 1. Evaluate the effectiveness of the PCM program compared to control in reducing PTSD and other mental health symptoms and improving health-related quality-of-life; and examine the mediating and moderating effects for use of, perceived barriers to, and satisfaction with health care (at 6 and 12 months). 2. Assess the success of the PCM program implementation through descriptive analysis of monthly reports and patient registry data maintained by CMs e.g., level of implementation for each intervention component and percent of patients assessed, treated, and referred over 12 month's time. 3. Examine the direct cost of the PCM program compared to control using exploratory analysis of staffing time, salaries, and resources data obtained from participating CHC staff. PUBLIC HEALTH RELEVANCE: This proposed research project is relevant to public health because its goal is to improve the health of underserved populations seen in community health centers. We propose to implement and evaluate a primary care program that addresses multiple patient-, clinician-, and system- level barriers to services for those who suffer from post-traumatic stress disorder (PTSD), a common disorder in these settings.

描述（由申请人提供）：创伤后应激障碍 (PTSD) 在一般人群中很常见（终生患病率为 9-17%；Bruce 等人，2001；Fifer 等人，1994；Gillock 等人，2005；Neria 等人，2006；Stein 等人，2000）和初级保健患者（高达 35%；Gillock 等人， 2005）。大多数患有常见精神健康障碍的人并不向精神健康专家寻求治疗（Kessler等，1994；1995），而是向初级保健临床医生（PCC）寻求治疗。尽管有针对 PTSD 的治疗方法，但患者、临床医生和系统障碍使大多数人无法获得足够的护理（Lecrubier，2004；Samson 等，1999；Stein 等，2000；Stein 2003；Kessler，2000；Jaycox 等，2004）。因此，需要采取一些方法来消除创伤后应激障碍患者的障碍并增加治疗机会。我们通过借鉴改善抑郁症初级保健的大量工作（Wells et al., 2000, 2004; Rost et al., 2002; Dietrich et al., 2004; Rubenstein et al., 2006; Meredith et al., 2000, 2006）以及我们的探索/发展工作（R34MH070683）来弥补这一差距。基于社区的参与性研究（CBPR）方法来确定可行的策略 克服提供和接受 PTSD 护理的障碍。我们提议进行一项为期 5 年的后续随机试验，以测试 PTSD 护理管理 (PCM) 计划对从社区卫生中心 (CHC) 寻求初级护理的患者的影响。我们的提案涉及 NIMH 的优先事项，即 PA-07-312“暴力和创伤的心理健康后果 (R01)”中概述的“了解初级保健中组织、实施、融资和提供心理健康服务的有效方式”。我们将来自 6 个 CHC 的 400 名患者随机分为 PCM 干预组 (N=200) 或对照组 (N=200)。干预措施包括通过护理经理 (CM) 实施的组成部分和策略：1) 患者教育，2) 患者筛查和向 PCC 的反馈，3) 临床医生教育和指南的使用，4) 初级保健和心理健康临床医生之间的结构化反馈，5) 患者护理的连续性，以及 6) 详细说明可用社区服务的资源指南。控制条件仅包括临床医生教育和患者筛查，没有反馈。具体来说，我们的目标是： 1. 与对照相比，评估 PCM 计划在减少 PTSD 和其他心理健康症状以及改善与健康相关的生活质量方面的有效性；并检查医疗保健的使用、感知障碍和满意度的中介和调节效应（6 个月和 12 个月时）。 2. 通过对 CM 维护的月度报告和患者登记数据进行描述性分析，评估 PCM 计划实施的成功与否，例如每个干预组成部分的实施水平以及 12 个月内接受评估、治疗和转诊的患者百分比。 3. 通过对从参与 CHC 工作人员获得的人员配备时间、工资和资源数据进行探索性分析，检查 PCM 计划与对照计划的直接成本。 公共卫生相关性：该拟议研究项目与公共卫生相关，因为其目标是改善社区卫生中心服务不足人群的健康。我们建议实施和评估初级保健计划，以解决为患有创伤后应激障碍（PTSD）（这些环境中的常见疾病）的患者提供服务的多个患者、临床医生和系统层面的障碍。