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BACKGROUND/RATIONALE:
BACKGROUND/RATIONALE: This proposal, submitted in response to the HSR&D Program Announcement on Deployment Health Services Research (6/05), focuses on mental health, an HSR&D priority area. We propose to conduct a randomized clinical trial of collaborative care for the management of PTSD in VA primary care settings. Helping Primary Care Clinicians manage PTSD is important because PTSD occurs in 11-36% of primary care patients. It is neither feasible nor necessary to refer all cases of PTSD to mental health, and the VA/DoD practice guideline for PTSD emphasizes the management of PTSD in primary care. Furthermore, some patients may prefer to receive mental health care from their Primary Care Clinician. However, there have been no randomized trials of primary care-based treatment for PTSD patients.
Our approach is based on 3CM, the Three-Component Model of care for depression, the most common comorbid disorder in PTSD. 3CM is a promising model for VA because it can be used across a range of primary care settings, from a small CBOC to a large VAMC. 3CM consists of (1) a prepared practice, (2) care management, and (3) enhanced mental health support. In the RESPECT-D trial, a randomized clinical trial focused on treating depressed patients in primary care, 3CM resulted in greater patient satisfaction and improved outcomes relative to usual care. We have adapted 3CM to the treatment of PTSD and are gathering pilot data on its effectiveness in active duty personnel at Ft. Bragg.
OBJECTIVE(S):
OBJECTIVES: The immediate objectives are to implement collaborative care in 5 VA primary care clinics to facilitate the management of PTSD and evaluate the effects on patient outcomes, provider behavior, and costs. The long-term objectives are to generate information to support implementation research on collaborative care for PTSD, and ultimately, implementation of collaborative care for PTSD in VHA.
METHODS:
METHODS: Our study builds on the RESPECT-D trial and the Fort Bragg pilot by extending the population to male and female VA primary care patients. Across 5 VA sites, 220 patients with PTSD who are not receiving mental health care will be randomized to receive 3CM or usual care. They will be assessed prior to treatment and 3 and 6 months following treatment initiation. Outcomes will be monitored in three domains: the patient, the process of care, and the cost of delivering care. PTSD symptom severity is the primary outcome. We propose to test the following questions:
1. What are the effects of 3CM on patient outcomes? We expect that 3CM, relative to usual care, will result in greater decreases in symptom severity, improvements in functioning, and higher satisfaction with care at 3- and 6-months.
2. What are the effects of 3CM on care delivery? We expect that 3CM, relative to usual care, will result in greater likelihood of patients receiving guideline-based care, follow-up visits, and follow-up calls. In addition, we expect provider satisfaction to increase.
3. What are the additional costs of delivering 3CM? We will estimate the cost of care in each study arm to determine the difference in total cost associated with the observed difference in primary outcome.
FINDINGS/RESULTS:
Project Not Yet Started
IMPACT:
IMPACT: Because RESPECT-D showed that 3CM enhanced the likelihood of patients receiving guideline-informed care, our study could help clinicians follow VA/DoD guidelines for the treatment of PTSD and improve outcomes for VA PTSD patients. The information obtained in this study complements the increased use of telehealth strategies to optimize the delivery of VA care. Besides helping primary care clinicians manage PTSD patients, the study will provide information that can help VA planners and policymakers facilitate the implementation of collaborative care system-wide.
PUBLICATIONS:
None at this time.
DRA:
Health Services and Systems, Military and Environmental Exposures
DRE:
Treatment, Quality of Care
Keywords:
Organizational issues, Outpatient, Deployment Related
MeSH Terms:
none
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