Internet-based self-help programs provide a potentially effective platform for increasing Veteran access to evidence-based mental health treatment for disorders common in primary care such as depression, anxiety, and insomnia. Because of their advantages, Congress mandated that VA implement such programs in the Veterans' Mental Health and Other Care Improvements Act of 2008. However, efforts to develop and evaluate strategies to implement internet-based self-help programs have been limited. In prior work, a strategy was developed to implement a range of programs and consists of four components: (1) a clinical intermediary for patient support, (2) provider/staff facilitation and education, (3) patient education, and (4) stepped-care for those requiring additional treatment. A recent pilot study at VA Connecticut demonstrated the feasibility of this strategy when implementing a self-help program for insomnia in outpatient care.
The upcoming work has three objectives: (1) adapt the previously tested strategy to current VA primary care organizations, (2) test the effectiveness of the strategy and the clinical outcomes of an internet-based self-help program for insomnia in VA Connecticut primary care, and (3) explore the development of informatics-based processes to track the diffusion of internet-based self-help program use throughout VA.
The implementation strategy will be adapted through identification of barriers and facilitators to internet-based self-help program implementation using qualitative analysis of semi-structured interviews and focus groups with VA-wide primary care leadership and members of local VA Connecticut primary care teams. The effectiveness of the implementation strategy and clinical outcomes of the program for insomnia, compared to a low-intensity (control) strategy, will be evaluated in a hybrid implementation-effectiveness clinical trial. Outcomes will be evaluated over a six-month period and the sustainment of implementation over an additional year. The diffusion of internet-based self-help program use across VA will be evaluated using information retrieval from a national dataset of VA clinical notes to identify instances of program use and to target VA providers who are early- and non-adopters of such programs for semi-structured interviews.
Not yet available.
The implementation strategy developed and tested through this research can be used by VA providers, administrators, and policy makers to increase access to evidence-based mental healthcare, decrease barriers to care, and increase productivity. This research will directly impact VA providers by expanding efficacious, non-pharmacologic alternatives for treating mild to moderate mental health problems in primary care. This research will impact Veteran health by increasing access to mental healthcare, particularly in the early stages of disorders common in primary care treatment. Veteran well-being will be improved through intervention-related improvements in health outcomes and self-efficacy. Risk to Veterans may also lessen through the decreased use of potentially harmful psychotropic medications.
- Hermes E, Burrone L, Perez E, Martino S, Rowe M. Implementing Internet-Based Self-Care Programs in Primary Care: Qualitative Analysis of Determinants of Practice for Patients and Providers. JMIR mental health. 2018 May 18; 5(2):e42.
- Johnston JAY, Wang F, Liu J, Blond BN, Wallace A, Liu J, Spencer L, Cox Lippard ET, Purves KL, Landeros-Weisenberger A, Hermes E, Pittman B, Zhang S, King R, Martin A, Oquendo MA, Blumberg HP. Multimodal Neuroimaging of Frontolimbic Structure and Function Associated With Suicide Attempts in Adolescents and Young Adults With Bipolar Disorder. The American journal of psychiatry. 2017 Jul 1; 174(7):667-675.
- Hermes EG, de Oliveira Bastos PR. The Prevalence of Teachers' Vocal Symptoms in Municipal Network of Education in Campo Grande, Mato Grosso do Sul, Brazil. Journal of voice : official journal of the Voice Foundation. 2016 Nov 1; 30(6):756.e1-756.e7.
- Hermes E, Rosenheck R. Psychopharmacologic Services for Homeless Veterans: Comparing Psychotropic Prescription Fills Among Homeless and Non-Homeless Veterans with Serious Mental Illness. Community mental health journal. 2016 Feb 1; 52(2):142-7.
Mental, Cognitive and Behavioral Disorders, Health Systems
Technology Development and Assessment, Treatment - Efficacy/Effectiveness Clinical Trial