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CDA 15-262 – HSR&D Study

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CDA 15-262
Improving Primary Care Anxiety Treatment Engagement and Effectiveness
Robyn L. Shepardson PhD
Syracuse VA Medical Center, Syracuse, NY
Syracuse, NY
Funding Period: April 2017 - March 2022

BACKGROUND/RATIONALE:
Many Veteran primary care patients experience impairing anxiety symptoms, but treatment rates are low. Primary Care-Mental Health Integration (PC-MHI), in which mental health clinicians provide brief treatment in the primary care setting, can bridge the gap between demand for, and availability of, effective anxiety treatment. However, brief anxiety interventions suitable for use in the PC-MHI setting are needed to address a gap in VHA treatment options.

OBJECTIVE(S):
The overall objective is to develop, refine, and evaluate a brief anxiety intervention that will be acceptable to Veterans and feasible for PC-MHI providers. Aim 1: Examine PC-MHI providers' usual care practices for anxiety treatment and perceived feasibility of using evidence-based intervention techniques. Aim 2: Develop an adapted brief, Veteran-centered PC-MHI intervention for anxiety (with or without comorbid depression), then refine the treatment manual based on patient and provider feedback. Aim 3: Conduct a pilot RCT to evaluate feasibility, acceptability, implementation barriers and facilitators, and effectiveness (versus usual care).

METHODS:
Aim 1 is a qualitative study (N=18) sampling VHA PC-MHI providers. Aim 2 involves adapting existing evidence-based, cognitive-behavioral intervention techniques for delivery in a brief PC-MHI format that can accommodate various anxiety presentations and comorbid depressive symptoms. We will incorporate Aim 1 findings to reduce provider implementation challenges and pilot study findings on Veterans' treatment preferences to enhance patient engagement. We will obtain PC-MHI provider (N=4) feedback on feasibility of the intervention and then conduct a small open trial (N=5) to obtain Veteran feedback on acceptability, which together will inform further refinements to the treatment manual. Aim 3 will be a pilot hybrid type I effectiveness-implementation RCT (N=48) to evaluate feasibility, acceptability, intervention effectiveness in reducing anxiety symptom severity (vs. usual care), and implementation barriers and facilitators.

FINDINGS/RESULTS:
Not yet available.

IMPACT:
This project aims to address a critical need for evidence-based anxiety interventions suitable for the PC-MHI setting for Veterans experiencing anxiety who prefer to be treated in primary care. Attending to Veterans' treatment preferences will enhance acceptability, and incorporating PC-MHI provider feedback regarding implementation challenges will improve feasibility of delivery.

PUBLICATIONS:

Journal Articles

  1. Possemato K, Johnson EM, Beehler GP, Shepardson RL, King P, Vair CL, Funderburk JS, Maisto SA, Wray LO. Patient outcomes associated with primary care behavioral health services: A systematic review. General hospital psychiatry. 2018 Jul 1; 53:1-11.
  2. Shepardson RL, Buchholz LJ, Weisberg RB, Funderburk JS. Psychological interventions for anxiety in adult primary care patients: A review and recommendations for future research. Journal of anxiety disorders. 2018 Mar 1; 54:71-86.


DRA: Mental, Cognitive and Behavioral Disorders
DRE: Treatment - Comparative Effectiveness
Keywords: none
MeSH Terms: none