Improving Communication Between Primary Care Providers and Their Trauma Patients

改善初级保健提供者与创伤患者之间的沟通 摘要 创伤，特别是人际暴力，与各种情绪抱怨、焦虑和 抑郁障碍和人际关系问题以及增加的医疗发病率减少了 预防性保健，增加了卫生保健系统的费用。然而，与创伤相关的问题并没有 在提供者的培训或初级保健环境中得到了足够的重视，提供者感到没有准备好 和这些病人一起工作。拟议的研究利用R34机制来适应和中试一种理论-- 基于有效处理创伤幸存者的实用方法，风险连接课程，以 适用于为低收入和少数族裔患者服务的初级保健提供者(PCP)。以下目标 建议：1)调整现有的治疗工作手册和培训课程 创伤幸存者应适合初级保健提供者。风险连接(RC)是一种基于理论的 教服务提供者如何在各种环境下与创伤幸存者合作的实用方法， 注重促进成长和治愈关系。适应的过程包括多个 根据专家小组的经验进行的修改，方案文件的广泛投入，以及对 给病人的课程。2)评估课程和相关材料的初步可接受性。 这一目标包括早期试行具有16个项目控制计划的培训课程，并对其进行定性调查。 可行性和可接受性。它还侧重于澄清课程可能涉及的与理论相关的领域 影响提供者的行为以及患者的评估和结果。3)实施对照研究 在区域安全网临床站点对初级保健医生进行调整培训。四个小组，每组八个PCP将是 随机进入训练或等待名单(延迟)条件；等待名单组将在重新评估后接受训练 在延迟之后。将在基线和培训后评估训练组和对照组的结果，以及 延迟组将在培训后再次进行评估。主要结果将由以下代码组成 独立评分者，基于标准化/模拟患者(SP)在以下地区对PCP的录音访问 理论上与RC培训相结合。次要结果包括可接受性和可行性 对提供者的干预，提供者对所学技能的自我评估，提供者对提供者技能的评级 访问后的SP，使用话语分析对访问的子集进行评级，以及对 PCP实际患者的子集。对一些提供者长达18个月的跟踪调查将探索其程度 目标行为的持续收益。该研究计划的长期目标是通过以下方式支持初级保健计划 为他们提供多种策略来解决他们患者的身体和心理健康投诉， 后续研究致力于可持续性和患者结局。这项研究将补充其他 我们的创伤和社区中心正在为低收入患者开发干预措施，他们的 提供者，以及他们接受治疗的安全网护理系统。叙述性 拟议的研究计划旨在调整和试行小学课程 护理提供者(PCP)，帮助他们更有效地处理创伤幸存者的工作。我们 计划：(1)调整现有的治疗工作手册和培训课程 创伤幸存者适合进行PCP，(2)评估初始可接受性 向提供者和患者提供课程和材料；以及(3)进行对照研究 调整后的培训，所有这些培训的重点都是为低收入人口服务的提供者。 为初级保健医生提供多种策略，以解决身心健康问题 对他们病人的投诉将改善对弱势群体的初级保健。

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. Narrative 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.