NDLI: The effects of a prolonged exposure workshop with and without consultation on provider and patient outcomes: a randomized implementation trial

Content Provider	Springer Nature : BioMed Central
Author	Foa, Edna B. McLean, Carmen P. Brown, Lily A. Zang, Yinyin Rosenfield, David Zandberg, Laurie J. Ealey, Wayne Hanson, Brenda S. Hunter, Lora Rose Lillard, Ivett J. Patterson, Thomas J. Rosado, Julio Scott, Valerie Weber, Charles Wise, Joseph E. Zamora, Charles D. Mintz, Jim Young-McCaughan, Stacey Peterson, Alan L.
Abstract	Background Prolonged 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. Methods This 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)). Results Extended condition providers reported greater improvements in self-efficacy, b = .83, 95% CI [.38, 1.27], t(79) = 3.71, p = .001, and d = .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, and d = .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, and d = .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, and d = .66. Conclusions Post-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 registration Clinicaltrials.gov , NCT02982538 . Registered December 5, 2016; retrospectively registered
Related Links	https://implementationscience.biomedcentral.com/counter/pdf/10.1186/s13012-020-01014-x.pdf
Ending Page	14
Page Count	14
Starting Page	1
File Format	HTM / HTML
ISSN	17485908
DOI	10.1186/s13012-020-01014-x
Journal	Implementation Science
Issue Number	1
Volume Number	15
Language	English
Publisher	BioMed Central
Publisher Date	2020-07-29
Access Restriction	Open
Subject Keyword	Health Services Research Public Health Health Informatics Health Policy Health Administration Health Promotion and Disease Prevention Prolonged exposure PTSD Provider training Consultation
Content Type	Text
Resource Type	Article
Subject	Health Policy Public Health, Environmental and Occupational Health Health Informatics
Journal Impact Factor	8.8/2023
5-Year Journal Impact Factor	9.2/2023

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1	Ministry of Education (GoI), Department of Higher Education	Sanctioning Authority	https://www.education.gov.in/ict-initiatives
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4	Project PI / Joint PI	Principal Investigator and Joint Principal Investigators of the project	Dr. B. Sutradhar bsutra@ndl.gov.in Prof. Saswat Chakrabarti will be added soon
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