RESUMO
BACKGROUND: Blended models of therapy, which incorporate elements of both internet and face-to-face methods, have been shown to be effective, but therapists and patients have expressed concerns that fewer face-to-face therapy sessions than self-guided internet sessions may be associated with lower therapeutic alliance, lower program completion rates, and poorer outcomes. OBJECTIVE: A multisite quasi-experimental comparison study with a noninferiority design implemented in routine clinical care was used to assess webSTAIR, a 10-module blended therapy derived from STAIR (skills training in affective and interpersonal regulation) for trauma-exposed individuals delivered with 10 weekly therapist sessions (termed Coach10) compared to 5 biweekly sessions (Coach5). It was hypothesized that Coach5 would be as good as Coach10 in a range of outcomes. METHODS: A total of 202 veterans were enrolled in the study with 101 assigned to Coach5 and 101 to Coach10. Posttraumatic stress disorder (PTSD) symptoms, depression, emotion regulation, interpersonal problems, and social functioning measures were collected pre-, mid-, and posttreatment, and at a 3-month follow-up. Noninferiority analyses were conducted on symptom outcome measures. Comparisons were made of continuous and categorical measures regarding participant and therapist activities. RESULTS: Participants reported moderate to severe levels of baseline PTSD, depression, or both. Significant reductions were obtained in all symptom measures posttreatment and at the 3-month follow up. Coach5 was not inferior to Coach10 in any outcome. Therapeutic alliance was at an equivalently high level across the 2 treatment conditions; completion rates and web usage were similar. Total session time was substantially less for the Coach5 therapists than the Coach10 therapists. Both programs were associated with a low, but equal number of therapist activities related to scheduling and crisis or motivational sessions. CONCLUSIONS: A blended model delivered with 5 sessions of therapist support was noninferior to 10 sessions in individuals with moderate to severe symptoms. Future studies identifying patient characteristics as moderators of outcomes with high versus low doses of therapist support will help create flexible, technology-based intervention programming.
RESUMO
BACKGROUND: Despite the 2006 U.S. Centers for Disease Control and Prevention (CDC) recommendations for routine HIV testing in health care settings, many persons remain untested. PURPOSE: To determine physician barriers to HIV testing, we surveyed primary care physicians in community health centers in a high HIV prevalence city. METHODS: Primary care physicians were invited via e-mail to participate in a Web-based survey. One hundred and thirty-seven physicians participated (response rate: 43.9%). RESULTS: Fifty-five physicians (41.0%) were unaware of updated CDC HIV testing recommendations. Physicians were unaware that testing should be routinely offered in primary care settings caring for adolescents (62 physicians, 45.6%) and primary care settings caring for adults (33, 24.3%). Physicians were also unaware that teenage years patients aged 13 to 17 years (68, 49.6%) and adult patients aged 18 to 64 years (40, 29.2%) should be routinely HIV tested. CONCLUSION: With the new 2013 US Preventive Services Task Force recommendations to support routine HIV testing, it is critical to address ongoing physician HIV testing barriers to mitigate the HIV epidemic.
