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BACKGROUND/RATIONALE:
Telemedicine has the potential to profoundly influence the delivery of specialized care to the remote veteran population suffering with PTSD. Preliminary research supports telemedicine technology as a possible solution to improve access to mental health services for veterans with PTSD. The proposed research is a treatment-outcome study that will assess the clinical efficacy of conducting an Anger Management Therapy (AMT) group treatment intervention using a videoteleconferencing (VTC) modality as compared to the traditional in-person modality with veterans who have PTSD and reside in remote locations on the Hawaiian Islands. AMT is a manual-guided cognitive-behavioral, skill based group intervention that has been used nationwide in VA substance abuse programs and most recently has been adopted by many VA PTSD Clinical Teams to treat anger-related to the sequelae of PTSD
OBJECTIVE(S):
The immediate objective of this project is to expand upon previous pilot findings by evaluating the clinical effectiveness of providing mental health services via VTC modality as compared to the traditional in-person modality for veterans with PTSD who reside in remote locations. We expect to find that providing AMT using the VTC modality will be equally effective as providing AMT using the traditional in-person modality. The long-range objective of this project is to develop an empirically sound telemedicine protocol that will enable the extension of manual-guided clinical services to remote sites in a clinically effective manner through the use of VTC technology.
METHODS:
A prospective, randomized evaluation of clinical and process outcomes for a cognitive-behavioral AMT group will be used to assess the effectiveness of using VTC modality as compared to traditional in-person modality. Approximately 180 male veterans with PTSD and anger related difficulties will be recruited from 3 Hawaiian Island clinical sites by VA primary care staff and Vet Center staff located on the corresponding neighbor island. Veterans will be randomly assigned to either the experimental VTC AMT group, or the control in-person AMT group. The manual-guided AMT consists of 12 session over 6 weeks with each session lasting 1.5 hours. Clinincal outcomes measures will be assesed pre-treatment, post-treatmet and at 3 and 6-months follow-up. Demonstration of equivalence between VTC and traditional-in-person modalities will be conducted using equivalence (non-inferiority) statistics. Testing the non-inferiority of the VTC mode of delivery to the In-Person mode will be carried out through a modified hypothesis testing procedure
FINDINGS/RESULTS:
Our preliminary data support the feasibility of this modality for specialized care with combat veterans who have PTSD. We are currently in the process of analyzing our initial outcome data. However our visual inspection of clinical outcome measures for completers suggests equivalent symptom ratings between the two conditions. In the majority of these cohorts attrition was less than 10% which is substantially lower than what is typically found in clinical settings. Participants in the VTC condition anecdotally report a high degree of satisfaction with the treatment modality and report substantial clinical impact for them and their families. Qualitative interviews with participants who have completed this project indicate that this treatment has improved their interpersonal and day-to-day functioning in both conditions. The referring providers at the remote clinical sites have been exceptionally positive about this study. In this clinical trial to date we have completed over 120 group therapy sessions by VTC with participants who have PTSD and anger difficulties - to date we have not had to cancel or discontinue any session due to clinical or technical difficulties. We have not had any serious adverse events related to teh project.
IMPACT:
The recent interest in telemedicine in the VA system suggests the need for randomized trials comparing telemedicine services with traditional in-person services. Although telemedicine programs are surfacing across the nation, research that addresses the clinical effectiveness of this mode of service delivery is still desperately needed. This study will examine the clinical effectiveness of AMT via VTC modality. Further, findings from this project may support the establishment of a telemedicine infastructure in the VA system to provide care to veterans where distance limits access to specialized care. It is expected that this project will lead to results that can be applied to other VA situations where specialized clinical PTSD services, such as anger management groups, are needed but not available due to geographic distance.
PUBLICATIONS:
None at this time.
DRA:
Health Services and Systems, Military and Environmental Exposures, Special (Underserved, High Risk) Populations
DRE:
Treatment
Keywords:
Access, Telemedicine, Deployment, Operation Iraqi Freedom
MeSH Terms:
none
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