Deploying a telemedicine collaborative care intervention for posttraumatic stress disorder in the US Department of Veterans Affairs: A stepped wedge evaluation of an adaptive implementation strategy

被引：8

作者：

Fortney, John C. ^{[1
,2
,16
]}

Rajan, Suparna ^{[1
]}

Reisinger, Heather S. ^{[3
,4
]}

Moeckli, Jane ^{[3
]}

Nolan, John P.

Wong, Edwin S. ^{[1
,5
]}

Rise, Peter ^{[1
]}

V. Petrova, Valentina ^{[1
]}

Sayre, George G. ^{[1
]}

Pyne, Jeffrey M. ^{[6
,7
]}

Grubaugh, Anouk ^{[8
,9
]}

Simsek-Duran, Fatma ^{[10
,11
]}

Grubbs, Kathleen M. ^{[12
,13
]}

Morland, Leslie A. ^{[12
,13
]}

Felker, Bradford ^{[1
,2
]}

Schnurr, Paula P. ^{[14
,15
]}

机构：

[1] VA Puget Sound Hlth Care Syst, VA HSR &D Ctr Innovat Vet Ctr & Value Driven Care, Seattle, WA USA

[2] Univ Washington, Dept Psychiat & Behav Sci, Seattle, WA USA

[3] Iowa City VA Hlth Care Syst, VA HSR &D Ctr Access & Delivery Res & Evaluat, Iowa City, IA USA

[4] Univ Iowa, Dept Internal Med, Iowa City, IA USA

[5] Univ Washington, Dept Hlth & Syst & Populat Hlth, Seattle, WA USA

[6] Cent Arkansas Vet Healthcare Syst, VA HSR&D Ctr Mental Hlth & Outcomes Res, Little Rock, AR USA

[7] Univ Arkansas Med Sci, Dept Psychiat, Little Rock, AR USA

[8] VA HSR&D Charleston Hlth Equ & Rural Outreach Inno, Charleston, SC USA

[9] Med Univ South Carolina, Dept Psychiat, Charleston, SC USA

[10] Iowa City VA Hlth Care Syst, Iowa City, IA USA

[11] Univ Iowa, Dept Psychiat, Iowa City, IA USA

[12] VA San Diego Healthcare Syst, San Diego, CA USA

[13] Univ Calif San Diego, Dept Psychiat, San Diego, CA USA

[14] VA Med Ctr, Natl Ctr PTSD, White River Jct, VT USA

[15] Geisel Sch Med Dartmouth, Hanover, NH USA

[16] Univ Washington, Sch Med, Dept Psychiat & Behav Sci, Div Populat Hlth, 1959 NE Pacific St,Box 356560, Seattle, WA 98195 USA

来源：

GENERAL HOSPITAL PSYCHIATRY | 2022年 / 77卷

关键词：

COGNITIVE PROCESSING THERAPY; HEALTH; PTSD;

D O I：

10.1016/j.genhosppsych.2022.03.009

中图分类号：

R749 [精神病学];

学科分类号：

100205 ;

摘要：

Objective: To address barriers to trauma-focused psychotherapy for veterans with posttraumatic stress disorder (PTSD), we compared two implementation strategies to promote the deployment of telemedicine collaborative care. Method: We conducted a Hybrid Type III Effectiveness Implementation trial at six VA medical centers and their 12 affiliated Community Based Outpatient Clinics. The trial used a stepped wedge design and an adaptive implementation strategy that started with standard implementation, followed by enhanced implementation for VA medical centers that did not achieve the performance benchmark. Implementation outcomes for the 544 veterans sampled from the larger population targeted by the intervention were assessed from chart review (care management enrollment and receipt of trauma-focused psychotherapy) and telephone survey (perceived access and PTSD symptoms) after each implementation phase. The primary outcome was enrollment in care management. Results: There was no significant difference between standard implementation and enhanced implementation on any of the implementation outcomes. 41.6% of sampled veterans had a care manager encounter, but only 6.0% engaged in trauma-focused psychotherapy. Conclusions: While telemedicine collaborative care was shown to be effective at engaging veterans in trauma-focused psychotherapy in a randomized controlled trial, neither standard nor enhanced implementation strategies were sufficient to support successful deployment into routine care.

引用

页码：109 / 117

页数：9

共 26 条

[1]

[Anonymous], 2017, VA/DOD Clinical Practice Guideline for the Management of Posttraumatic Stress Disorder and Acute Stress Disorder

[2] Effectiveness-implementation Hybrid Designs Combining Elements of Clinical Effectiveness and Implementation Research to Enhance Public Health Impact [J].