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BACKGROUND/RATIONALE:
Sporadic outpatient treatment attendance contributes to high rates of relapse and rehospitalization among veterans with posttraumatic stress disorder (PTSD). Telephone case monitoring has improved treatment adherence and reduced relapse among patients with chronic medical and substance use disorders, but has not been previously tested in PTSD patients. Pilot research by our group indicates the intervention is feasible, acceptable to patients, and reduces time from discharge to competion of a first outpatient visit.
OBJECTIVE(S):
The proposed multisite randomized controlled trial will test whether providing telephone monitoring to PTSD patients after discharge from residential treatment improves retention in aftercare, thereby improving patient functioning and reducing psychiatric rehospitalization. Major objectives are to determine whether telephone monitoring results in a) improved clinical outcomes (less violence, substance use, and PTSM symptoms; and b) longer time to rehospitalization. This study will also assess how telephone case monitoring impacts costs of care.
METHODS:
This study will be a multi-site randomized controlled trial. A total of 1,400 subjects will be recruited from 8 PTSD residential treatment programs (one women's program and seven programs serving predominantly men) located at 7 VA medical centers. All patients completing at least 4 days of residential PTSD treatment and discharging to VA outpatient care will be eligible to participate. Within each site, subjects will be randomized to receive either usual referral to outpatient mental health care after discharge OR usual outpatient mental health care plus telephone case monitoring. Subjects in the telephone monitoring condition will receive biweekly telephone calls during the first three months after discharge to encourage treatment adherence and provide problem-solving support. Patient demographics and baseline clinical assessments will be collected by questionnaire at intake. Patients will be surveyed by mail 4 and 12 months after discharge to assess psychiatric symptoms, substance use, and violence. VA inpatient and outpatient treatment utilization data will be obtained from the VA National Patient Care Database. If patients receive care from Vet Centers, their Vet Center counselors will also be surveyed to quantify patient use of outpatient care. Primary intent-to-treat analyses will use hierarchical linear modeling to compare the one-year course of substance use, violence, PTSD symptoms, and depression symptoms in the telephone monitoring and usual care groups. Survival analysis will be used to compare conditions on time to rehospitalization. Cost-outcome analyses will compare costs associated with the intervention relative to usual care and estimate costs per unit of improved outcome. Secondary analyses will assess whether differences in outcomes between the telephone case monitoring and usual care groups are mediated by improved attendance in outpatient care.
FINDINGS/RESULTS:
No data have been analyzed yet (recruitment and fielding are underway).
IMPACT:
Demand for VA PTSD treatment is increasing as troops return from combat deployments in Afghanistan and Iraq. Telemedicine is likely to be an important component in developing more effective and efficient models of PTSD care that improve access to treatment and reduce wait times for services. It is hoped that using telephone case monitoring as an inexpensive adunct to standard care may improve clincal outcomes and reduce rehospitalization among veterans with chronic PTSD. If telephone monitoring proves to be a effective adjunct to care, fuuture research can assess whether telephone monitoring can partially replace face-to-face case case management without sacrificing quality of care, in order to improve access to services, decrease clinic wait times, and reduce costs.
PUBLICATIONS:
None at this time.
DRA:
Health Services and Systems, Military and Environmental Exposures, Substance Abuse, Addictive Disorders
DRE:
Treatment
Keywords:
Deployment Related, Operation Enduring Freedom, Operation Iraqi Freedom
MeSH Terms:
none
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