The effects of a prolonged exposure workshop with and without consultation on provider and patient outcomes: a randomized implementation trial
| Autor: | Charles Weber, Carmen P. McLean, Charles D. Zamora, Joseph E. Wise, Lora Rose Hunter, Thomas J. Patterson, Yinyin Zang, Edna B. Foa, Valerie Scott, Julio Rosado, Alan L. Peterson, Lily A. Brown, Brenda S. Hanson, Laurie J. Zandberg, Stacey Young-McCaughan, Ivett J. Lillard, Jim Mintz, David Rosenfield, Wayne Ealey |
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| Jazyk: | angličtina |
| Rok vydání: | 2020 |
| Předmět: |
050103 clinical psychology
medicine.medical_specialty Case consultation education Implosive Therapy Health Informatics Health administration Stress Disorders Post-Traumatic 03 medical and health sciences 0302 clinical medicine Medicine Humans 0501 psychology and cognitive sciences Referral and Consultation lcsh:R5-920 Prolonged exposure therapy Consultation business.industry Health Policy Research 05 social sciences Provider training Public Health Environmental and Occupational Health Hybrid type Health services research PTSD General Medicine Prolonged exposure Self Efficacy 030227 psychiatry Posttraumatic stress Military Personnel Treatment Outcome Military health Physical therapy lcsh:Medicine (General) business |
| Zdroj: | Implementation Science : IS Implementation Science, Vol 15, Iss 1, Pp 1-14 (2020) |
| ISSN: | 1748-5908 |
| Popis: | BackgroundProlonged exposure therapy (PE) is an evidence-based treatment for posttraumatic stress disorder (PTSD) that is underutilized in the military health system. Standard workshop training in PE may not be sufficient to alter provider behavior, but post-workshop consultation requires significant resources. Therefore, it is important to determine the incremental utility of post-workshop consultation.MethodsThis study used a hybrid type III randomized implementation trial at 3 US Army installations. Providers were randomized to receive a 4-day prolonged exposure workshop (Standard training condition,n= 60), or the prolonged exposure workshop followed by 6–8 months of post-workshop expert case consultation (Extended training condition,n= 43). The effects training condition were examined on provider attitudes (self-efficacy in delivering PE, expectations for patient improvement, and beliefs about PE), use of PE and PE components, and clinical outcomes of patients with PTSD (using the Clinician-Administered PTSD Scale (CAPS-5)).ResultsExtended condition providers reported greater improvements in self-efficacy,b= .83, 95% CI [.38, 1.27],t(79) = 3.71,p= .001, andd= .63. A greater proportion of patients in the Extended condition (44%) than in the Standard condition (27%) received at least 1 PE session,b= .76,t(233) = 2.53,p= .012, and OR = 2.13. Extended condition providers used more PE components (M= .9/session) than did Standard condition providers (M= .5/session),b= .54, 95% CI [.15, .93],t(68) = 2.70,p= .007, andd= .68. Finally, decrease in patients’ PTSD symptoms was faster for patients of Extended condition providers than for patients of Standard condition providers,b= − 1.81, 95% CI [− 3.57, − .04],t(263) = − 2.02,p= .045, andd= .66, and their symptoms were lower at the second assessment,b= − 5.47, 95% CI [− 9.30, − 1.63],t(210) = − 2.81,p= .005, andd= .66.ConclusionsPost-workshop consultation improved self-efficacy for delivering PE, greater use of PE, faster PTSD reduction, and lower PTSD severity at the second assessment. To our knowledge, this is the first demonstration that post-workshop case consultation for PE improves patient outcomes.Trial registrationClinicaltrials.gov,NCT02982538. Registered December 5, 2016; retrospectively registered |
| Databáze: | OpenAIRE |
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