Feasibility, acceptability, and effectiveness of a web-based therapeutic intervention for post-traumatic stress disorder among American Indian/Alaska Native adults in primary care (Preprint)

BACKGROUND Posttraumatic stress disorder (PTSD) is a major public health concern among American Indian and Alaska Native (AI/AN) populations. Primary care clinics are often the first point of contact for AI/AN people seeking health care and are feasible locations for trauma-focused interventions. OBJECTIVE Web-based therapeutic interventions (WBTI) for PTSD have the potential to reduce PTSD symptoms in AI/AN primary care patients by offering culturally tailored psychoeducation and symptom self-management tools. In this study, we investigate the feasibility and acceptability in two AI/AN serving primary care sites and effectiveness of a WBTI on trauma symptom changes in a 12-week period. METHODS A community-based participatory research process was used to refine the WBTI adaptations and content, and conduct a feasibility test of the resultant 16-guide intervention “Health is Our Tradition: Balance and Harmony after Trauma” within two AI/AN healthcare settings. AI/AN people ages 18 years and older who were not in crisis and scored positive on the primary care PTSD instrument completed baseline measures and were trained on WBTI usage. Participants were provided weekly tip via text message during the 12-week intervention. Content was devised to reinforce website use, complement website content, and remind participants about follow-up visits. At each visit, participants completed follow-up versions of all baseline measures (except demographics) including the PC-PTSD and a satisfaction/acceptability questionnaire. Electronic health records were collected for the periods extending to 12 months prior to study enrollment and 3 months following study enrollment. Changes in perceptions of acceptability/feasibility between the 6-week and 12-week follow-up were examined with paired t-tests. Analysts explored changes in symptomatology over the 12-week intervention with one-way ANOVAs for repeated measures or repeated measures logistic regression tests. To examine the effect of the intervention on service utilization, analysts compared clinic visit frequency from the health record data in the 12 months before the intervention (divided by 4 for comparison) and the 3 months after it with paired t-tests. The Wilcoxon Signed Rank Test for non-parametric data was used to test significance for non-normally distributed data. RESULTS In a sample of N=24, the WBTI was well received with no difference in use, engagement, satisfaction or technical skills needed for use by age or gender. Website usage decreased significantly over the course of the 12-week intervention period yet participants reported significant reductions in PTSD, depression, and physical symptoms related to PTSD, and problematic alcohol use over the same period of WBTI usage. CONCLUSIONS The website shows promise for integration into primary care and behavioral health settings to augment and improve access to treatment of the health consequences of trauma exposure among adult AI/AN primary care patients.

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An Internet-Based Therapeutic Tool for American Indian/Alaska Native Adults With Posttraumatic Stress Disorder: User Testing and Developmental Feasibility Study

JMIR Formative Research ◽

10.2196/13682 ◽

2019 ◽

Vol 3 (4) ◽

pp. e13682

Author(s):

Vanessa Y Hiratsuka ◽

Laurie Moore ◽

Jaedon P Avey ◽

Lisa G Dirks ◽

Barbara D Beach ◽

...

Keyword(s):

Primary Care ◽

American Indian ◽

Alaska Native ◽

Stress Disorder ◽

Alaska Natives ◽

Ptsd Symptoms ◽

Web Based ◽

Study Enrollment ◽

Culturally Adapted ◽

Website Use

Background Posttraumatic stress disorder (PTSD) is a major public health concern among American Indian and Alaska Native populations. Primary care clinics are often the first point of contact for American Indian and Alaska Natives seeking health care and are feasible locations for trauma-focused interventions. Objective Web-based therapeutic interventions have the potential to reduce PTSD symptoms by offering psychoeducation and symptom self-management tools. We investigated the feasibility of a culturally adapted Web-based therapeutic intervention in two American Indian and Alaska Native–serving primary care sites. We developed and tested a self-guided Web-based therapeutic intervention aimed at improving knowledge and awareness of, and provision of guidance, support, and symptom-management for, PTSD symptoms. Methods A community-based participatory research process was used to refine adaptations to the veteran’s administration’s PTSD Coach Online, to develop new content, and to guide and interpret the results of the feasibility pilot. This process resulted in a 16-guide intervention “Health is Our Tradition: Balance and Harmony after Trauma” website. The feasibility pilot included 24 American Indian and Alaska Natives aged 18 years and older who scored positive on a primary care PTSD screener. Enrolled participants completed a demographic questionnaire, an experience with technology questionnaire, and baseline behavioral health measures. Once measures were complete, research staff described weekly text messages, minimum study expectations for website use, and demonstrated how to use the website. Feasibility measures included self-reported website use, ratings of satisfaction and perceived effectiveness, and website metrics. Feasibility of obtaining measures for an effectiveness trial was also assessed to include behavioral health symptoms and service utilization through self-report instruments and electronic health record queries. Self-reported measures were collected at enrollment and at 6 and 12 weeks post enrollment. Electronic health records were collected from 12 months before study enrollment to 3 months following study enrollment. Changes between enrollment and follow-up were examined with paired t tests, analysis of variance or logistic regression, or the Wilcoxon signed rank test for nonnormally distributed data. Results The culturally adapted website and associated text message reminders were perceived as satisfactory and effective by participants with no differences by age or gender. The majority of participants (86%, 19/24) reported use of the website at 6 weeks and nearly all (91%, 20/22) at 12 weeks. At 6 weeks, 55% (12/22) of participants reported using the website at the recommended intensity (at least three times weekly), dropping to 36% (8/22) at 12 weeks. Participant use of modules varied from 8% (2/24) to 100% (24/24), with guide completion rates being greater for guides that were only psychoeducational in nature compared with guides that were interactive. There were no significant changes in patterns of diagnoses, screening, medications, or service utilization during exposure to the website. Conclusions “Health is Our Tradition: Balance and Harmony after Trauma” shows promise for an effectiveness pilot.

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Development of a Screening and Brief Intervention Process for Symptoms of Psychological Trauma Among Primary Care Patients of Two American Indian and Alaska Native Health Systems

The Journal of Behavioral Health Services & Research ◽

10.1007/s11414-016-9519-6 ◽

2016 ◽

Vol 44 (2) ◽

pp. 224-241 ◽

Cited By ~ 7

Author(s):

Vanessa Y. Hiratsuka ◽

Laurie Moore ◽

Denise A. Dillard ◽

Jaedon P. Avey ◽

Lisa G. Dirks ◽

...

Keyword(s):

Primary Care ◽

American Indian ◽

Health Systems ◽

Brief Intervention ◽

Alaska Native ◽

Psychological Trauma ◽

Screening And Brief Intervention ◽

Intervention Process ◽

Primary Care Patients

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Chronicity in Posttraumatic Stress Disorder and Predictors of the Course of Posttraumatic Stress Disorder Among Primary Care Patients

The Journal of Nervous and Mental Disease ◽

10.1097/01.nmd.0000110287.16635.8e ◽

2004 ◽

Vol 192 (2) ◽

pp. 153-159 ◽

Cited By ~ 46

Author(s):

Caron Zlotnick ◽

Benjamin F. Rodriguez ◽

Risa B. Weisberg ◽

Steven E. Bruce ◽

Michael A. Spencer ◽

...

Keyword(s):

Primary Care ◽

Posttraumatic Stress Disorder ◽

Posttraumatic Stress ◽

Stress Disorder ◽

Primary Care Patients

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Occupational functioning and employment services use among VA primary care patients with posttraumatic stress disorder.

Psychological Trauma Theory Research Practice and Policy ◽

10.1037/tra0000241 ◽

2018 ◽

Vol 10 (2) ◽

pp. 140-143 ◽

Cited By ~ 3

Author(s):

Rebecca K. Sripada ◽

Jennifer Henry ◽

Matheos Yosef ◽

Debra S. Levine ◽

Kipling M. Bohnert ◽

...

Keyword(s):

Primary Care ◽

Posttraumatic Stress Disorder ◽

Posttraumatic Stress ◽

Stress Disorder ◽

Occupational Functioning ◽

Employment Services ◽

Primary Care Patients ◽

Services Use

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Abstract 18144: Mobile Phone Text Messaging Improves Antihypertensive Drug Adherence in the Community

Circulation ◽

10.1161/circ.130.suppl_2.18144 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Paola Varleta ◽

Carlos Akel ◽

Monica Acevedo ◽

Claudia Salinas ◽

Javier Pino ◽

...

Keyword(s):

Blood Pressure ◽

Primary Care ◽

Mobile Phone ◽

Antihypertensive Drug ◽

Educational Level ◽

Text Messaging ◽

Health Concern ◽

Drug Adherence ◽

Hypertensive Patients

Introduction: Hypertension is a major public health concern and the leading cause of cardiovascular disease worldwide. Prevalence of adequate blood pressure control is low and it is mainly associated to poor antihypertensive drug adherence. We hypothesized that education through mobile phone text messaging (SMS) would improve antihypertensive drug adherence in hypertensive patients followed in a primary care setting. Methods: Recently diagnosed hypertensive patients receiving antihypertensive drug treatment for less than 6 months were randomised to receive SMS related to improve drug adherence and to follow a healthy life style or no messages. Exclusion criteria were history of stroke, heart failure, myocardial infarction and hemodialysis. Patients were recruited from 12 different primary care clinics in Santiago, Chile, where free antihypertensive drug therapy was provided. All patients signed an informed consent after which a survey was performed. Compliance was assessed using Morinsky- Green-Levine Questionnaire.Text messages were sent every 12± 2 days. After a 6-month follow-up, a new survey was applied. An Ordinary Least Squares regression model was used to analyse the net difference between the two groups. Results: A total of 314 subjects were recruited, mean age 60 ±10 years, 35% male, 67% with low or medium educational level (≤12 years). Mean drug pill number was 2.1 per day and the mean time of drug prescription was 4±1 months; 150 subjects were randomised to text messages. No statistical difference between the control and the intervention groups in regards to gender, age, educational level, blood pressure and baseline compliance was found. Eleven patients were lost of follow-up. Adherence in the control group decreased from to 59,7 % at baseline to 51,7% ( p<0,05) at 6 months. By contrast, in the intervention group, it increased from 50,9 % to 62,7 % ( p<0,05). The absolute difference in mean adherence rate between the two groups was 19,8 % (Standard error: 0.081, p: 0.015). Conclusion: This study shows that education through SMS in patients with recently prescribed antihypertensive drugs improved adherence to treatment. SMS could become a good and easy- to- use intervention tool to overcome low adherence to drug treatments in the community.

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Two-year effectiveness of a stepped-care depression prevention intervention and predictors of incident depression in primary care patients with diabetes type 2 and/or coronary heart disease and subthreshold depression: data from the Step-Dep cluster randomised controlled trial

BMJ Open ◽

10.1136/bmjopen-2017-020412 ◽

2018 ◽

Vol 8 (10) ◽

pp. e020412 ◽

Cited By ~ 1

Author(s):

Alide Danielle Pols ◽

Marcel C Adriaanse ◽

Maurits W van Tulder ◽

Martijn W Heymans ◽

Judith E Bosmans ◽

...

Keyword(s):

Primary Care ◽

Coronary Heart Disease ◽

Heart Disease ◽

Cumulative Incidence ◽

Stepped Care ◽

Subthreshold Depression ◽

Depression Prevention ◽

Primary Care Patients

IntroductionMajor depressive disorders (MDD), diabetes mellitus type 2 (DM2) and coronary heart disease (CHD) are leading contributors to the global burden of disease and often co-occur.ObjectivesTo evaluate the 2-year effectiveness of a stepped-care intervention to prevent MDD compared with usual care and to develop a prediction model for incident depression in patients with DM2 and/or CHD with subthreshold depression.MethodsData of 236 Dutch primary care patients with DM2/CHD with subthreshold depression (Patient Health Questionnaire 9 (PHQ-9) score ≥6, no current MDD according to the Mini International Neuropsychiatric Interview (Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition criteria)) who participated in the Step-Dep trial were used. A PHQ-9 score of ≥10 at minimally one measurement during follow-up (at 3, 6, 9, 12 and 24 months) was used to determine the cumulative incidence of MDD. Potential demographic and psychological predictors were measured at baseline via web-based self-reported questionnaires and evaluated using a multivariable logistic regression model. Model performance was assessed with the Hosmer-Lemeshow test, Nagelkerke’s R2explained variance and area under the receiver operating characteristic curve (AUC). Bootstrapping techniques were used to internally validate our model.Results192 patients (81%) were available at 2-year follow-up. The cumulative incidence of MDD was 97/192 (51%). There was no statistically significant overall treatment effect over 24 months of the intervention (OR 1.37; 95% CI 0.52 to 3.55). Baseline levels of anxiety, depression, the presence of >3 chronic diseases and stressful life events predicted the incidence of MDD (AUC 0.80, IQR 0.79–0.80; Nagelkerke’s R20.34, IQR 0.33–0.36).ConclusionA model with 4 factors predicted depression incidence during 2-year follow-up in patients with DM2/CHD accurately, based on the AUC. The Step-Dep intervention did not influence the incidence of MDD. Future depression prevention programmes should target patients with these 4 predictors present, and aim to reduce both anxiety and depressive symptoms.Trial registration numberNTR3715.

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Tele-ECG consulting and outcomes on primary care patients in a low-to-middle income population: the first experience from Makassar telemedicine program, Indonesia

BMC Family Practice ◽

10.1186/s12875-020-01325-4 ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Idar Mappangara ◽

Andriany Qanitha ◽

Cuno S. P. M. Uiterwaal ◽

Jose P. S. Henriques ◽

Bastianus A. J. M. de Mol

Keyword(s):

Primary Care ◽

Female Gender ◽

Middle Income ◽

Healthcare Facilities ◽

Primary Care Settings ◽

Lower Blood ◽

History Of ◽

Primary Care Patients ◽

Male Patients

Abstract Background Telemedicine has been a popular tool to overcome the lack of access to healthcare facilities, primarily in underprivileged populations. We aimed to describe and assess the implementation of a tele-electrocardiography (ECG) program in primary care settings in Indonesia, and subsequently examine the short- and mid-term outcomes of patients who have received tele-ECG consultations. Methods ECG recordings from thirty primary care centers were transmitted to Makassar Cardiac Center, Indonesia from January to July 2017. We cross-sectionally measured the performance of this tele-ECG program, and prospectively sent a detailed questionnaire to general practitioners (GPs) at the primary care centers. We performed follow-up at 30 days and at the end of the study period to assess the patient outcomes. Results Of 505 recordings, all (100%) ECGs were qualified for analysis, and about half showed normal findings. The mean age of participants was 53.3 ± 13.6 years, and 40.2% were male. Most (373, 73.9%) of these primary care patients exhibited manifested CVD symptom with at least one risk factor. Male patients had more ischemic ECGs compared to women (p < 0.01), while older age (> 55 years) was associated with ischemic or arrhythmic ECGs (p < 0.05). Factors significantly associated with a normal ECG were younger age, female gender, lower blood pressure and heart rate, and no history of previous cardiovascular disease (CVD) or medication. More patients with an abnormal ECG had a history of hypertension, known diabetes, and were current smokers (p < 0.05). Of all tele-consultations, GPs reported 95% of satisfaction rate, and 296 (58.6%) used tele-ECG for an expert opinion. Over the total follow-up (14 ± 6.6 months), seven (1.4%) patients died and 96 (19.0%) were hospitalized for CVD. Of 88 patients for whom hospital admission was advised, 72 (81.8%) were immediately referred within 48 h following the tele-ECG consultation. Conclusions Tele-ECG can be implemented in Indonesian primary care settings with limited resources and may assist GPs in immediate triage, resulting in a higher rate of early hospitalization for indicated patients.

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Efficacy of Using Physical Activity Mentors to Increase the Daily Steps of Older Adults in the Primary Care Setting: A Pilot Study

Journal of Aging and Physical Activity ◽

10.1123/japa.2012-0120 ◽

2014 ◽

Vol 22 (1) ◽

pp. 16-24 ◽

Cited By ~ 5

Author(s):

Karen A. Croteau ◽

Vijiayurani Suresh ◽

Elanna Farnham

Keyword(s):

Physical Activity ◽

Older Adults ◽

Primary Care ◽

Pilot Study ◽

Repeated Measures ◽

Care Setting ◽

Primary Care Setting ◽

Chronic Illnesses ◽

Main Effects

The purpose of this pilot study was to determine if using physical activity (PA) mentors has any additional impact on daily steps of older adults participating in the Maine in Motion (MIM) program in the primary care setting. Participants were randomly assigned to a MIM-only group (n= 14) or a MIM+ mentor group (n= 14). The MIM intervention lasted 6 months with follow-up at 12 months. Average age of participants was 64 ± 8.8 years and most participants had multiple chronic illnesses. At baseline, mean body mass index (BMI) was 32.2 ± 5.1 and average daily steps were 4,236 ± 2,266. Repeated-measures ANOVA revealed significant main effects for steps,F(2.324, 59.104) = 4.168,p= .015, but no main effects for group,F(1, 25) = 2.988,p= .096, or time-by-group interaction,F(2.324, 59.104) = 0.905,p= .151. All participants significantly increased daily steps over the course of the intervention, with MIM+ participants maintaining increases at follow-up. No significant findings were found for BMI.

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