Although stigma associated with serious mental illness, substance abuse disorders, and depression has been studied very little is known about Posttraumatic Stress Disorder (PTSD). This study explored related to PTSD among treatment-seeking Operation Enduring Freedom Iraqi (OEF/OIF) combat veterans.Sixteen OEF/OIF veterans combat-related participated in focus groups. We used qualitative methods explore PTSD-related stigma.Common perceived stereotypes of included labels such as...

This article outlines a three-phase, team-based approach used to analyze qualitative data from nation-wide needs assessment of access Veteran Health Administration services for rural-dwelling veterans. The method described here was develop the trustworthiness findings analysis large set, without use analytic software. In Phase 1, we templates summarize content 205 individual semistructured interviews. During 2, matrix display constructed each 10 project sites synthesize and template by...

The Integrated-Promoting Action on Research Implementation in Health Services (i-PARIHS) framework and its predecessor, PARIHS, have been widely utilized implementation studies. Although i-PARIHS developers focused creating tools to guide facilitators application practice, are also needed for evaluation research. Codebooks with clear meaningful code labels definitions an important component of qualitative data analysis developed other used frameworks. There is no such codebook i-PARIHS....

Objectives: Chronic Obstructive Pulmonary Disease (COPD) is a progressive respiratory disease with high morbidity and mortality. COPD guidelines (CPG) are greatly underutilized studies attempting to improve this practice gap have yielded inconsistent results. We hypothesize that using implementation science can provide detailed understanding of these gaps the reasons behind them. Methods: Since primary care (PC) manages bulk patients, in pilot study, we use principles systematically explore...

In the HIV Translating Initiatives for Depression into Effective Solutions project, we conducted a randomized controlled effectiveness and implementation trial comparing depression collaborative care with enhanced usual in Veterans Health Administration clinics US. An offsite team including psychiatrist, manager (DCM), clinical pharmacist provided using stepped-care model of treatment made recommendations to providers through electronic health record system. The DCM delivered management...

Introduction Engaging service users or consumers in quality improvement implementing a new is important across settings and may reduce health inequities. Implementation strategies leveraging consumer engagement are neither commonly used nor robustly operationalized implementation science. Implementers (e.g., middle managers, facilitators) want to involve activities, but do not always feel confident how proceed. We developed compendium of tools called Consumer Voice guide others engage...

Up to 50% of veterans drop out trauma-focused evidence-based psychotherapies (TF-EBP) without completing treatment or recovering; evidence suggests this is in part because their posttraumatic stress disorder (PTSD) care insufficiently patient-centered. There also that measurement-based (MBC) for mental health should be personalized the patient, yet not common practice VA PTSD care.

The complex practice of measurement-based care (MBC) for mental health conditions has proven challenging to implement. This study aimed evaluate an intensive strategy implement MBC in U.S. Department Veterans Affairs (VA) Primary Care Mental Health Integration clinics.Ten paired sites were randomly assigned receive national resources alone or with implementation (external facilitation plus quality improvement teams) between May 2018 and June 2020. intervention occurred over 12-18 months; two...

Treatment of psychotic disorders consists primarily second generation antipsychotics, which are associated with metabolic side effects such as overweight/obesity, diabetes, and dyslipidemia. Evidence-based clinical practice guidelines recommend timely assessment management these conditions; however, research studies show deficits delays in monitoring for patients. This protocol article describes the project 'Monitoring Management Metabolic Side Effects Antipsychotics,' is testing an approach...

Aim To better understand barriers and facilitators that hinder or help women veterans discuss their alcohol use with providers in primary care order to identify problematic drinking enhance provider–patient communication about harmful drinking. Background Women presenting may be less likely than men disclose potentially use. No studies have qualitatively examined the perspectives of factors affect accurate disclosure by during routine clinic visits. Methods Providers ( n =14) were recruited...

Objective. This study examines organizational factors relating to climate and culture that might facilitate or impede the implementation of evidence-based practices (EBP) targeting behavioral health in federally qualified centers (FQHCs). Methods. Employees at six FQHCs participating an quality improvement (EBQI) initiative for mood disorders alcohol abuse were interviewed (N=32) surveyed using Organizational Context Survey (OCS) assessing (N=64). Results. The scored relatively well on...

Integrating mental health providers into primary care clinics improves access to and outcomes of care. In the Veterans Health Administration (VA) Primary Care Mental Integration (PCMHI) program, are co-located in clinics, but implementation this model is challenging outside large VA medical centers, especially for rural without full staffing. Long wait times care, little collaboration between providers, sub-optimal veterans could result. Telehealth be used provide PCMHI clinics; however,...

Abstract Background This paper reports on a qualitative evaluation of hybrid type II stepped-wedge, cluster randomized trial using implementation facilitation to implement team-based care in the form collaborative chronic model (CCM) interdisciplinary outpatient mental health teams. The objective this analysis is compare alignment sites’ clinical processes with CCM elements at baseline (time 1) and after 12 months 2) from perspective providers. Methods We conducted semi-structured interviews...

Interventions involving contact with a person who has recovered from mental illness are most effective at reducing stigma. This study sought input health care providers to inform the design of intervention intended reduce provider stigma toward persons serious illness. Using purposive sampling strategy, data were collected five Veterans Affairs hospitals in southeastern United States. Seven focus groups conducted, and 83 participated. A semistructured interview guide was used elicit...

Background: Facilitation is an effective strategy to implement evidence-based practices, often involving external facilitators (EFs) bringing content expertise implementation sites. Estimating time spent on multifaceted EF activities complex. Furthermore, collecting continuous time–motion data for facilitation tasks challenging. However, organizations need this information allocate resources Thus, our objectives were conduct a analysis of facilitation, and compare versus noncontinuous...

Purpose Progressive Tinnitus Management (PTM) is an evidence-based interdisciplinary stepped-care approach to improving quality of life for patients with tinnitus. PTM was endorsed by Department Veterans Affairs (VA) Audiology leadership in 2009. Factors affecting implementation are unknown. We conducted a study to: 1) estimate levels program VA and Mental Health clinics across the country; 2) identify barriers facilitators based on experiences audiologists mental health providers. Method...

The evidence-based Collaborative Chronic Care Model (CCM), developed to help structure care for chronic health conditions, comprises six elements: work role redesign, patient self-management support, provider decision clinical information systems, linkages community resources, and organizational/leadership support. As the CCM is increasingly implemented in real-world settings, there heightened interest understanding specific influences upon implementation. Therefore, guided by Integrated...

Introduction Implementation researchers could draw from participatory research to engage patients (consumers of healthcare) in implementation processes and possibly reduce healthcare disparities. There is a little consumer involvement implementation, partially because no formal guidance exists. We will create pilot toolkit methods consumers the US’ Veterans Health Administration (VHA) selecting tailoring strategies. This toolkit, Consumer Voice, provide on what, when, where, how why an...