Evaluation of implementation facilitation integrated into a national mentoring programme to improve access to evidence-based psychotherapy for post-traumatic stress disorder within the veterans health administration: a quality improvement report.

Autor:	Sayer NA; CCDOR, Minneapolis VA Health Care System, Minneapolis, Minnesota, USA nina.sayer@va.gov.; Department of Psychiatry and Behavioral Sciences, University of Minnesota, Minneapolis, MN, USA.; Department of Medicine, University of Minnesota, Minneapolis, MN, USA., Maieritsch KP; Executive Division, National Center for PTSD, White River Junction VA Medical Center, White River Junction, Vermont, USA., Yamokoski CA; Executive Division, National Center for PTSD, White River Junction VA Medical Center, White River Junction, Vermont, USA., Orazem RJ; CCDOR, Minneapolis VA Health Care System, Minneapolis, Minnesota, USA., Clothier BA; CCDOR, Minneapolis VA Health Care System, Minneapolis, Minnesota, USA., Noorbaloochi S; CCDOR, Minneapolis VA Health Care System, Minneapolis, Minnesota, USA.; Department of Medicine, University of Minnesota, Minneapolis, MN, USA.
Jazyk:	angličtina
Zdroj:	BMJ open quality [BMJ Open Qual] 2024 Jan 12; Vol. 13 (1). Date of Electronic Publication: 2024 Jan 12.
DOI:	10.1136/bmjoq-2023-002449
Abstrakt:	Despite the resources dedicated to specialised mental healthcare for patients with post-traumatic stress disorder (PTSD) within the US Veterans Health Administration, evidence-based psychotherapies (EBPs) for PTSD have been underutilised, as evidenced by low EBP reach to patients. A research-operation collaboration evaluated whether implementation facilitation delivered by regional PTSD mentors as part of a national mentoring programme improved EBP reach compared with less-intensive quality improvement interventions. We used a non-equivalent comparison-group design that included all PTSD clinics with low EBP reach at baseline (n=51). Clinics were grouped into one of four quality improvement conditions according to self-selection by regional PTSD mentors: facilitation (n=6), learning collaborative (n=15), mentoring as usual in the regions that had facilitation-target clinics (n=15) and mentoring as usual in other regions (n=15). The primary outcome was EBP reach among therapy patients with PTSD at preintervention baseline and postintervention sustainment periods. We used the ratio of odds ratios ( ROR ) between the two time periods to evaluate the effectiveness of facilitation compared with the other conditions, adjusting for patient-level and clinic-level confounders. 26 126 veterans with PTSD received psychotherapy in one of 51 low-reach PTSD clinics during preintervention baseline and postintervention sustainment periods. The odds of a patient receiving an EBP increased over time across conditions. The adjusted ORs of a patient receiving an EBP from baseline to sustainment were 1.35-1.69 times larger in clinics that received facilitation compared with the three comparison conditions (adjusted ROR s of comparison condition versus facilitation ranged from 0.59 (95% CI 0.47 to 0.75) to 0.74 (95% CI 0.58 to 0.94)). Implementation facilitation can be integrated into a national programme for quality improvement for PTSD specialty care and may be particularly useful when less-intensive approaches are not sufficiently effective. Competing Interests: Competing interests: The authors are VHA employees. NAS received VHA research funding. The authors have no other competing interests to declare. (© Author(s) (or their employer(s)) 2024. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
Databáze:	MEDLINE
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