Prolonged Exposure (PE) for PTSD: Telemedicine vs. In Person

摘要 项目背景/理由：目前约有15%至17%的伊拉克战争退伍军人符合全面诊断标准 MH问题如创伤后应激障碍（PTSD）的标准（Hoge等，2004年）。延长 暴露（PE）是一种经验支持的创伤后应激障碍（PTSD）治疗方法（Foa 1997; Schnurr等人，2007年），并在 被VAMC采用作为该疾病的治疗选择之一，正如VAMC赞助的 全国培训临床医生使用PE。因此，重要的是采用治疗递送方法， 最大限度地提高所有有需要的退伍军人，包括居住在农村地区的退伍军人， 由于接受心理健康治疗的耻辱而避免VAMC设置的人将接受干预 如PE。2005年5月，退伍军人事务委员会，健康小组委员会已经确定 远程医疗作为VA的优先领域，以满足这一需求。目前的建议是研究体育 通过远程医疗提供与亲自提供PE一样有效。远程医疗因其 克服精神卫生保健的两个主要障碍的能力（Frueh等人，2000年）： 农村居住的退伍军人在到达VAMC设施时面临的困难，以及退伍军人认为与之相关的耻辱感。 接受心理健康治疗事实上，如果有效，通过远程医疗提供的PE可以解决 42%的PTSD筛查阳性者表示他们对PTSD感兴趣， 在接受帮助，但只有25%的人实际上接受服务（霍格等人，2006年）。 项目目标：虽然创伤后应激障碍的有效治疗方法存在，并已被VAMC采用， 社会护理的障碍（例如，耻辱）和地理（例如，农村）的性质，防止许多退伍军人在需要 接受护理。远程医疗可以满足这一需求。本研究的主要目的是确定 通过远程医疗提供的PE在（1）临床;（2）过程;和（3）方面与面对面PE一样有效。 经济成果。 项目方法：我们建议使用组间随机重复测量（基线，治疗后， 治疗，3和6个月的随访）设计，226名OIF-OEF退伍军人诊断为PTSD，以评估 相对有效性，从症状、患者满意度和成本方面衡量，通过 远程医疗与面对面格式。我们假设没有差异（即，非劣效性） 格式将在治疗收益、患者满意度、治疗损耗、患者满意度和 直接医疗费用。 对退伍军人医疗保健的预期影响：本研究将提供有关以下方面的重要信息： 通过基于家庭的远程医疗设备提供的PE是否与传统的亲自交付一样有效 治疗创伤后应激障碍如果被证明是有效的人的治疗，一个新的，创新的， 和成本效益的干预提供系统的创伤后应激障碍将有初步的实证支持。

ABSTRACT Project Background/Rationale: Approximately 15 to 17% of current Iraq war veterans meet full diagnostic criteria for MH problems such as post-traumatic stress disorder (PTSD) (Hoge et al., 2004). Prolonged Exposure (PE) is an empirically supported treatment for PTSD (Foa 1997; Schnurr et al., 2007), and has been adopted by the VAMC as one of the treatments of choice for the disorder, as evident by the VAMC-sponsored national training of clinicians to use PE. It is therefore important to employ treatment delivery methods that maximize the likelihood that all veterans in need, including veterans residing in rural settings, and veterans who avoid VAMC settings due to the stigma of receiving mental health treatment, will receive interventions such as PE. The May, 2005 Committee on Veterans Affairs, Subcommittee on Health has identified Telemedicine as a VA priority area to address this need. The present proposal is to study whether PE delivered via Telemedicine is as effective as PE delivered In Person. Telemedicine has been chosen for its ability to overcome what appear to be two major barriers to mental health care (Frueh et al., 2000): the difficulty that rural-residing veterans face in reaching VAMC facilities, and the stigma veterans perceive related to receiving mental health treatment. Indeed, if effective, PE delivered via telemedicine may address the problem inherent in the finding that 42% of those screening positive for PTSD indicate that they are interested in receiving help, but only 25% actually receive services (Hoge, et al., 2006). Project Objectives: Although effective treatments for PTSD exist and have been adopted by the VAMC, barriers to care of a social (e.g., stigma) and geographic (e.g., rural) nature prevent many veterans in need from receiving care. Telemedicine might address this need. The major objective of this study is to determine if PE delivered via Telemedicine is as effective as In Person PE in terms of (1) clinical; (2) process; and (3) economic outcomes. Project Methods: We propose to use a randomized between groups repeated measures (baseline, post- treatment, 3& 6-month followups) design with 226 OIF-OEF veterans diagnosed with PTSD to assess the relative effectiveness, measured in terms of symptoms, patient satisfaction, and costs, of PE delivered via Telemedicine vs. In Person formats. We hypothesize that no differences (i.e., non-inferiority) between the two formats will be evident in terms treatment gains, patient satisfaction, treatment attrition, patient satisfaction and direct healthcare costs. Anticipated Impacts on Veterans Healthcare: This study will provide important information regarding whether PE delivered via home-based Telemedicine equipment is as effective as traditional In Person delivery of PE for post-traumatic stress disorder. If shown to be as effective as In Person treatment, a new, innovative, and cost effective intervention delivery system for PTSD will have initial empirical support.