A Pilot Randomized Clinical Trial of a Collaborative Care Intervention for Spanish-Speaking Injury Survivors.

Abstract

Objective: The goal of this investigation was to assess the feasibility and acceptability of collaborative care intervention delivery for physically injured Spanish-speaking patients admitted to a level I trauma center.

Method: The investigation was a secondary analysis of Spanish-speaking patients embedded within a larger comparative effectiveness trial. Participants were 22 male and female Spanish, non-English, speaking survivors of intentional and unintentional injuries, ages ≥18. Patients who were identified to be at elevated risk on the electronic health record evaluation were screened for ≥1 severe posttraumatic concern, and a score of ≥35 on the DSM-IV PTSD Checklist. Screen positive patients were randomized to collaborative care intervention versus enhanced usual care control conditions. The intervention included care management and evidence-based psychotherapeutic elements and pharmacotherapy targeting PTSD symptoms. The primary outcomes were PTSD symptoms, any post-injury concerns and emergency department/inpatient utilization over the 12-month post-injury period.

Results: The pilot study achieved >75% follow-up rates at 1-3-, 6-, 9- and 12-months post-injury. Elements of the collaborative care intervention were feasibly delivered and acceptable to Spanish-speaking patients. Mixed-model regression analyses revealed no statistically significant intervention or control group differences for any of the three primary outcomes over the course of the 12 months after the injury for the intent-to-treat sample.

Conclusions: A collaborative care intervention for Spanish-speaking injury survivors with PTSD symptoms and multiple post-injury concerns was feasibly and acceptably delivered. The intervention warrants testing with a larger scale, adequately powered, randomized clinical trial.