The Virtual Patient for Improving Quality of Care in Primary Healthcare

Traumatic experiences are associated with negative health behaviors, such as poor diet, smoking, sedentary lifestyle, and alcohol and substance abuse, and are also associated with post-traumatic stress disorder (PTSD) and depression. Refugees are an example of a highly-traumatized patient population who demonstrate high rates of PTSD, depression, and physical disabilities. Traumatized refugees seeking health care face many barriers related to socioeconomic status, cultural and medical worldviews, limited English proficiency, and low levels of health literacy. In order to care for this population, primary care providers (PCPs) must be: 1) aware of the trauma-related mental and physical health problems that refugee populations often experience, 2) knowledgeable of the barriers to health care that refugee populations may face and how to overcome them, and 3) able to identify and treat trauma as a medical and mental health risk factor in a culturally sensitive way.

This project developed and implemented a virtual patient, previously established as an efficient and cost-effective training tool, to help train PCPs in diagnosing and treating trauma-related medical and mental health conditions for refugee populations.

The specific aims of this project were as follows:

• Develop a virtual patient β-prototype from an existing α-prototype to be an effective and engaging learning tool for PCPs. 
• Test the ability of the virtual patient β-prototype to improve the primary care physicians’ identification and screening of health and mental health problems in traumatized and culturally diverse patients. 
• Test the ability of the virtual patient β-prototype to improve the primary care physicians’ treatment management plan of the health and mental health problems of traumatized diverse patients. 
• Assess the feasibility of expanding the use of the virtual patient among primary care physicians at neighborhood health centers. 

This feasibility project was conducted in two stages. First feedback and recommendations, collected from 10 PCPs undergoing the α-prototype training, were incorporated into the development of the β-prototype. The second phase consisted of a case-based assessment of 24 PCP’s knowledge of trauma before and after completing the β-prototype training. The case assessment showed assessments improved in some areas, but not in others.

This project was the first to educate and train PCPs on the diagnosis and treatment of a traumatized refugee patient in primary health care using a virtual patient. While readily accepted by PCPs, there is additional need for analysis to understand why trauma assessments did not improve in all areas with the use of the virtual patient.