Barriers and Potential Solutions to Implementing Evidence-Based PTSD Treatment in Military Treatment Facilities.

Autor:	McLean CP; National Center for PTSD, Dissemination and Training Division, VA Palo Alto Healthcare System, Menlo Park, CA 94025, USA.; Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA 94305, USA., Cook J; Center for Deployment Psychology, Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA.; Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD 20817, USA., Riggs DS; Center for Deployment Psychology, Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA., Peterson AL; Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA.; Research and Development Service, South Texas Veterans Health Care System, San Antonio, TX 78229, USA.; Department of Psychology, University of Texas at San Antonio, San Antonio, TX 78249, USA., Young-McCaughan S; Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA.; Research and Development Service, South Texas Veterans Health Care System, San Antonio, TX 78229, USA., Borah EV; Steve Hicks School of Social Work, University of Texas at Austin, Austin, TX 78712, USA., Comtois KA; Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA 98195, USA., Dondanville KA; Department of Psychiatry and Behavioral Sciences, The University of Texas Health Science Center at San Antonio, San Antonio, TX 78229, USA., Frick E; Center for Deployment Psychology, Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA.; Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD 20817, USA., Haddock CK; Social Sciences Innovations, Corp., New York, NY 10010, USA., Mann J; Center for Deployment Psychology, Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA.; Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD 20817, USA., Reynolds D; Center for Deployment Psychology, Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA.; Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD 20817, USA., Mistretta M; Center for Deployment Psychology, Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA.; Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD 20817, USA., Neitzer A; National Center for PTSD, Dissemination and Training Division, VA Palo Alto Healthcare System, Menlo Park, CA 94025, USA., Brzuchalski A; William Beaumont Army Medical Center, El Paso, TX 79920, USA.; Kimbrough Ambulatory Care Center, Fort Meade, MD 20755, USA., Clayton SP; 49th Medical Group, Holloman Air Force Base, Alamogordo, NM 88330, USA.; Nellis Air Force Base, NV 89191, USA., Conforte AM; Blanchfield Army Community Hospital, Fort Campbell, KY 42223, USA.; 3d Marine Division, UNIT 35840, Okinawa FPO AP 96602-5840, Japan., DuMars TD; William Beaumont Army Medical Center, El Paso, TX 79920, USA., Ekundayo K; 49th Medical Group, Holloman Air Force Base, Alamogordo, NM 88330, USA., Flores A; William Beaumont Army Medical Center, El Paso, TX 79920, USA., Hein J; Blanchfield Army Community Hospital, Fort Campbell, KY 42223, USA., Jinkerson J; 81st Medical Group, Keesler Air Force Base, Biloxi, MS 39534, USA.; Brooke Army Medical Center, Joint Base San Antonio-Fort Sam Houston, San Antonio, TX 78234, USA., Keith F; David Grant USAF Medical Center, Travis Air Force Base, Fairfield, CA 94533, USA.; Spangdahlem Air Base, Spangdahlem 09123, Germany., Kim HJ; Naval Hospital Jacksonville, Naval Air Station Jacksonville, Jacksonville, FL 32214, USA., Link JS; 81st Medical Group, Keesler Air Force Base, Biloxi, MS 39534, USA., Nofziger D; Center for Deployment Psychology, Department of Medical and Clinical Psychology, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA.; Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD 20817, USA.; Brooke Army Medical Center, Joint Base San Antonio-Fort Sam Houston, San Antonio, TX 78234, USA., Pollick K; Naval Hospital Jacksonville, Naval Air Station Jacksonville, Jacksonville, FL 32214, USA., Ringdahl EN; David Grant USAF Medical Center, Travis Air Force Base, Fairfield, CA 94533, USA., Waggoner J; 81st Medical Group, Keesler Air Force Base, Biloxi, MS 39534, USA., Woodworth C; Brooke Army Medical Center, Joint Base San Antonio-Fort Sam Houston, San Antonio, TX 78234, USA., Rosen CS; National Center for PTSD, Dissemination and Training Division, VA Palo Alto Healthcare System, Menlo Park, CA 94025, USA.; Department of Psychiatry and Behavioral Sciences, Stanford University, Palo Alto, CA 94305, USA.
Jazyk:	angličtina
Zdroj:	Military medicine [Mil Med] 2024 Feb 27; Vol. 189 (3-4), pp. 721-731.
DOI:	10.1093/milmed/usac240
Abstrakt:	Introduction: Prolonged exposure therapy is an effective treatment for posttraumatic stress disorder that is underutilized in health systems, including the military health system. Organizational barriers to prolonged exposure implementation have been hypothesized but not systematically examined. This multisite project sought to identify barriers to increasing the use of prolonged exposure across eight military treatment facilities and describe potential solutions to addressing these barriers. Materials and Methods: As part of a larger project to increase the use of prolonged exposure therapy in the military health system, we conducted a needs assessment at eight military treatment facilities. The needs assessment included analysis of clinic administrative data and a series of stakeholder interviews with behavioral health clinic providers, leadership, and support staff. Key barriers were matched with potential solutions using a rubric developed for this project. Identified facilitators, barriers, and potential solutions were summarized in a collaboratively developed implementation plan for increasing prolonged exposure therapy tailored to each site. Results: There was a greater than anticipated consistency in the barriers reported by the sites, despite variation in the size and type of facility. The identified barriers were grouped into four categories: time-related barriers, provider-related barriers, barriers related to patient education and matching patients to providers, and scheduling-related barriers. Potential solutions to each barrier are described. Conclusions: The findings highlight the numerous organizational-level barriers to implementing evidence-based psychotherapy in the military health system and offer potential solutions that may be helpful in addressing the barriers. (Published by Oxford University Press on behalf of the Association of Military Surgeons of the United States 2022. This work is written by (a) US Government employee(s) and is in the public domain in the US.)
Databáze:	MEDLINE
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