混合方法评估为什么实施试验未能让患有创伤后应激障碍的退伍军人参与创伤重点心理治疗
John C Fortney1,2, Suparna Rajan1, Jessica A Chen1,2
1VA Health Services Research and Development, Center for Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, Washington, USA.
Journal of traumatic stress
|June 28, 2023
概括
对创伤后应激障碍 (PTSD) 的远程医疗协作护理改善了症状,但很少有退伍军人开始以创伤为中心的心理治疗 (TFP). 许多退伍军人没有启动TFP,因为它没有被讨论,或者他们在讨论后拒绝了它.
科学领域:
- 心理健康 心理健康
- 远程医疗远程医疗
- 心理治疗研究 心理治疗研究
背景情况:
- 远程医疗协作护理显示出治疗创伤后应激障碍 (PTSD) 的前景.
- 有效性试验表明,在这种模式下,对创伤专注心理治疗 (TFP) 的参与度增加.
- 实施试验显示,尽管退伍军人已注册,但在启动TFP方面存在很大的差距.
研究的目的:
- 调查远程医疗协作护理计划中退伍军人中TFP启动的障碍.
- 了解患者和提供者对TFP非启动的看法.
- 在现实环境中识别导致TFP普及率低的因素.
主要方法:
- 混合方法评估结合了对1,071名患有PTSD的退伍军人的图表审查和对43名患者和58名提供者的半结构化访谈.
- 将患者分类为TFP讨论和启动小组.
- 对有关TFP障碍的提供者和患者采访的定性分析.
主要成果:
- 几乎一半的退伍军人 (48.6%) 没有与护理经理记录过TFP的讨论; 28.9%的人在讨论后拒绝了TFP.
- 在看心理健康专家的退伍军人中,36.8%从未讨论过TFP,35.7%讨论过但拒绝了.
- 医疗服务提供者指出患者对非创伤重点治疗的准备和偏好;患者指出以前的负面经历和避免创伤回忆.
结论:
- 远程医疗协作护理的潜力和实际的TFP启动之间存在显著的脱节.
- 障碍包括提供者缺乏TFP讨论,以及患者层面的因素,如准备和偏好.
- 共享决策工具可以促进知情讨论,并改善PTSD退伍军人的TFP参与.
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